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Case Study: Leg Pain


fiznat

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I don't usually do case studies this way, but I think the result is more interesting if we do a more interactive format this time. I'll give the basics, and (if you want) you guys ask me what you would like to know. We'll end up with the diagnosis (which I have), and hopefully a discussion about it.

Dispatched priority 1 for difficulty in breathing and leg pains.

On arrival you find a 30 year old male laying supine on the couch in care of first responders and family. The patient seems to be in mild distress has he lays still on the couch. He complains that he has been "feeling like shit" for the past week, including general weakness, malaise, and loss of appetite. About 2 hours before he called 911, the patient had a gradual (over about 30 mins) onset of severe leg pains, starting at the posterior quad area and radiating towards the ankles. He describes the pain as "squeezing" in nature and rates it at a 8 out of 10 (much worse when he moves). Shortness of breath seems to be a very secondary complaint compared to the leg pain.

VS:

Pt is AOx4 GCS 15

BP: 134/76

HR: 80

RR: 22

Lung sounds clear, skin pink/cool/diaphoretic

What would you like to know? (and please dont one person give me a huge list, let's try and get a few people involved)

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Is this a Hanson brother? Wasn't the elder Hason taken in for a leg pain/PE recently? Anyway...

1) Allergies/Meds/Hx

2) Prior history of same/normal level of activity?

3) Can he walk?

4) If he has been feeling shitty all week did he see his GP? Did he call just because of this new leg pain?

That's it for now.

Mmmmmm Bop...

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It was his arm.

Isaac Hanson Leaves Hospital After Surgery To Remove Blood Clot

AP - 10/5/2007 5:52 PM - Updated 10/5/2007 5:54 PM

DALLAS (AP) _ Isaac Hanson, the frontman of pop group Hanson, left the hospital Friday after doctors removed a blood clot that caused his right arm to painfully swell during a concert this week.

Hanson underwent surgery Thursday for venous thoracic outlet syndrome, which doctors said interrupted the blood flow from his arm back to his heart.

``It was definitely difficult to finish the rest of the show noticing that there was something serious going on,'' said Hanson, 26, whose arm remains bandaged.

Dr. Brad Grimsley, who performed the surgery, said Hanson will need to have a rib removed in the next few months to help open his vein and prevent another clot. He will remain on blood thinners in the meantime.

Hanson said he took some aspirin during the band's set at the House of Blues on Tuesday when his arm began hurting. Hanson, who also had a blood clot removed about four years ago, said he recognized he was probably going through the same thing again.

Grimsley said that while the condition isn't usually life threatening, there's a 40 percent chance of permanent disability if the condition isn't treated promptly.

``It's fortunate that he's so attune with his body,'' Grimsley said.

Hanson, best known for their 1997 hit ``MMMBop,'' plan to resume their tour Monday in Knoxville, Tenn., according to their Web site.

The three members of Hanson, who are all brothers, are from Tulsa, Okla.

Damn, we almost killed off a Hanson, soon they'll start dropping like Bee Gees.

Peace,

Marty

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Is this a Hanson brother? Wasn't the elder Hason taken in for a leg pain/PE recently? Anyway...

1) Allergies/Meds/Hx

2) Prior history of same/normal level of activity?

3) Can he walk?

4) If he has been feeling shitty all week did he see his GP? Did he call just because of this new leg pain?

That's it for now.

Mmmmmm Bop...

Hahaha not a Hanson brother I don't think. Pretty sure.

HX: Asthma, IDDM

RX: Albuterol, Novolog

All: PCN

Prior history: he had an episode like this "a few years ago," but doesn't remember any specific diagnosis. He thinks that the pain started in his hands while he was driving yesterday, and progressed to his legs. He's been feeling weak and tired lately, but has been carrying out his daily functions, walking, etc.... just more slowly.

hahahahahahaha GP thats funny. No he did not see (or probably have) a GP. For people of this sort, the ED is usually the acting GP if you know what I mean.

doo bei doo wah dooo bop

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Has he been doing any traveling or been laying around in bed alot?

Excellent! You're on the right track. Although above-the-knee presentation is much less common than below-the-knee, this guy is certainly at risk. The diagnosis you are thinking of must be presumed until it is ruled out in-patient.

This is one of those complaints that cannot be taken lightly, even without the difficulty breathing. A lot of urban firemonkeys would no-ride this, which would be a huge mistake.

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Taking his puffer a lot recently?

He took his puffer once this afternoon and his SOB has not changed.

any redness? cellulitis?

The skin is without any noticeable blemish.

Has he been doing any traveling or been laying around in bed alot?

He has been laying down more than usual due to his weakness/lethargy, but no traveling and he has managed to get up to go about his daily business for the past week.

As you are talking to him, the man grabs at the backs of his legs and yells in pain. He is rubbing his legs like he is sore, and when I ask, he says that rubbing his legs seems to make them feel a little better but the pain still comes and goes. He is at a 10-10 now and asks if I "have anything I can give [him]."

What else would you like to do?

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