ERDoc Posted October 10, 2012 Share Posted October 10, 2012 You are called to the residence of a 57y/o male. The patient tells you he has had progressively worsening chest pain over the lat 3 hours. It increases with a deep breath. He also has upper abd pain, more in the LUQ. The pt denies any sob. His son, who arrived home from college and found his father this way and called 911, tells you that his father's neck looks "bigger than normal". Take it away. Link to comment Share on other sites More sharing options...
P_Instructor Posted October 10, 2012 Share Posted October 10, 2012 Knee jerk reaction and thought.....any increased respiratory difficulty and or neck swelling due to sq air in tissues? (will go on from there) Link to comment Share on other sites More sharing options...
Arctickat Posted October 10, 2012 Share Posted October 10, 2012 Pericarditis. There, done, thanks for the great scenario. Link to comment Share on other sites More sharing options...
DFIB Posted October 10, 2012 Share Posted October 10, 2012 In addition to what has already been mentioned I would wonder about a right MI, pleuracy, possibly liver disease contributing to portal vascular disease or arterial dissetion. Vitals? JVD? Edema? Hx? Are his radial pulses bilaterally equal? Bilateral Blood Pressures? ECG? Link to comment Share on other sites More sharing options...
ERDoc Posted October 10, 2012 Author Share Posted October 10, 2012 Knee jerk reaction and thought.....any increased respiratory difficulty and or neck swelling due to sq air in tissues? (will go on from there) No resp distress or complaints of trouble breathing. His neck does appear symetrically swollen. When you palpate the neck you can feel subq emphysema. Pericarditis. There, done, thanks for the great scenario. Maybe, maybe not. Thanks for playing. In addition to what has already been mentioned I would wonder about a right MI, pleuracy, possibly liver disease contributing to portal vascular disease or arterial dissetion. Vitals? JVD? Edema? Hx? Are his radial pulses bilaterally equal? Bilateral Blood Pressures? ECG? HR 108 RR 16 BP 142/88 93% on room air No JVD No edema Has a hx of bipolar and schizophrenia Pulses/BPs equal bilat EKG sinus tach with a rate of 110 with nothing abnormal 1 Link to comment Share on other sites More sharing options...
mobey Posted October 10, 2012 Share Posted October 10, 2012 We pick up a gentleman with this presentation a few times a year. However, I am sure this is gonna be a zebra comparatively I am going to say get 2x IV in place TKVO for now, O2 via nasal cannula with EtC02 sidestream detector at 3lt. Sit him up, and ask him not to cough if at all possible. Now I'll spend a few seconds playing with the Sub-Q because it is just so cool..... Temp? History of a 'bleb' by chance? Transport to closest facility with chest tube capabilities and an x-ray department. BTW: Need to know if he is on thinners, as that will change my destination. Link to comment Share on other sites More sharing options...
Arctickat Posted October 10, 2012 Share Posted October 10, 2012 Pericarditis. There, done, thanks for the great scenario. Maybe, maybe not. Thanks for playing. Always a pleasure. 1 Link to comment Share on other sites More sharing options...
ERDoc Posted October 10, 2012 Author Share Posted October 10, 2012 We pick up a gentleman with this presentation a few times a year. However, I am sure this is gonna be a zebra comparatively I am going to say get 2x IV in place TKVO for now, O2 via nasal cannula with EtC02 sidestream detector at 3lt. Sit him up, and ask him not to cough if at all possible. Now I'll spend a few seconds playing with the Sub-Q because it is just so cool..... Temp? History of a 'bleb' by chance? Transport to closest facility with chest tube capabilities and an x-ray department. BTW: Need to know if he is on thinners, as that will change my destination. All treatments are done with no change. He says he enjoys you playing with his subq air and gives you an awkward smile. Temp 37.6 rectally (yes, you are that good). No history of blebs. No blood thinners, just anti-psych meds. Link to comment Share on other sites More sharing options...
paramedicmike Posted October 11, 2012 Share Posted October 11, 2012 Let's back up a little. OPQRST of this particular incident? Past medical history? Meds? Allergies? Link to comment Share on other sites More sharing options...
ERDoc Posted October 11, 2012 Author Share Posted October 11, 2012 Let's back up a little. OPQRST of this particular incident? Past medical history? Meds? Allergies? Thank you. Started 3 hours ago and has gotten worse. Pain is a sharp pain throughout the entire chest that increases with deep breaths. No shortness of breath. Upper abd pain is described as sharp, nonradiating and worse in the LUQ. Only past medical history is bipolar/schizophrenia and a colonoscopy this morning. No allergies and only meds are psych meds. Link to comment Share on other sites More sharing options...
Recommended Posts