25 replies to this topic

[HarryM]

So this is a case from our medical director he gave to us during our annual conference on clinical updates and where we are going clinically, what we do well and where we need to improve...

Background
Called to a 40yo male who collapsed while running. He has no prior medical history, taking no medications and is not allergic to anything he knows of. Prior to collapsing he complain of feeling very unwell with sudden onset 10/10 abdo pain (diffuse and states "pain is all over") and explosive diarrhoea.

Vitals
RR: 35/min with a shallow tidal volume
HR: 160/min with weak radial pulse
BP: 90/70
Cap Refill: 4 seconds
GCS: 13 (E3, V4, M6) - appears mildly confused and responding to voice
12-lead ECG: attached

 19-12-2012 8-43-57 a.m..jpg   74.77K   36 downloads

I'm not going to give you any other info now. When we went through this scenario we were given the above info and we had to ask for other information that we thought would be relevant and then make a treatment decision. So if you want more info ask for it and if I don't know it I'll make it up consistent with the actual diagnosis.

Edited by HarryM, 18 December 2012 - 07:57 PM.

[Arctickat]

Pericarditis with rapid colonic response?

[HarryM]

I've heard about your pericarditis fantasy Arcitckat...but that's not it.

[Arctickat]

DAMMIT!!!!!!!!!!!!!

[Curiosity]

Ill make up a pericarditis scenario for you next time.

What are the physical findings? Specifically abdo. Distention, tenderness, rigidity, guarding? Any recent trauma or illness?

Any weakness, numbness, tingling in extremities?

[HarryM]

No abnormal abdo findings. Pain does not change on palpation or percussion. Pain cannot be pinpointed at all and is across abdo. Mixture of cramping and sharp intermittent pain. Nil distension, rigidity or guarding. No recent trauma or illness. No weakness, numbess or tingling in extremities.

[fakingpatience]

Lung sounds? Skin condition/ color/ temp? You say he "collapsed," did he fall down, get dizzy, pass out? Did anyone witness his collapse and can describe it, specifically if there was any seizure like activity? What color is the diarrhea? Any nausea?

[Kiwiology]

ECG looks like SVT with rate about 160 and some non-specific ST depression

His pain makes me wonder if he has an aortic anyersim

With his physiological signs he is just enough this side of status 2 for me to call him that (unstable)

For now, simple ABCs and take him to the hospital

What was Tony Smith thinking?!

[HarryM]

Lung sounds are clear. Skin is flushed systemically and warm to touch with a temp of 37. He was witnessed to be running before slowing down for about 5 seconds before collapsing to the ground remaining conscious throughout. Pt states he had sudden onset abdo pain and felt need to pass bowel movement, he slowed down and became so dizzy he fell to the ground but remembers all events and was not KO'd or lost consciousness at any point. On the ground he lost bowel control.

Kiwi - not an aortic aneurism.

[Kiwiology]

Bloody hell I am fresh out of ideas then, ring up ICP and let them figure it out ...