firedoc5 Posted June 20, 2008 Author Share Posted June 20, 2008 Some guarding when palpating. Upper mid-abd., almost under the xiphoid process was becoming more painful. Sudden on-set of extreme fatigue just prior to arriving at ER. Link to comment Share on other sites More sharing options...
ERDoc Posted June 20, 2008 Share Posted June 20, 2008 Teenage female with syncope...pregnant until proven otherwise. Link to comment Share on other sites More sharing options...
chbare Posted June 20, 2008 Share Posted June 20, 2008 B/P in each arm? Pulses palpable in the lower extremities? History of contraceptive use? Smoker? High index of suspicion for an aneurism or dissection. Need to rule out pregnancy as well. Unfortunately, females have a few more parts that can malfunction when compared to their male counterparts making the diagnosis even more difficult. Take care, chbare. Link to comment Share on other sites More sharing options...
firedoc5 Posted June 20, 2008 Author Share Posted June 20, 2008 B/P in each arm? Pulses palpable in the lower extremities? History of contraceptive use? Smoker? High index of suspicion for an aneurism or dissection. Need to rule out pregnancy as well. Unfortunately, females have a few more parts that can malfunction when compared to their male counterparts making the diagnosis even more difficult. Take care, chbare. Ding, ding, ding, We have a winner. Dissecting aortic aneurism. No recent trauma. Birth defect never detected. Luckily she was not playing basketball or running track. Emergency surgery. Was back in action in nine weeks. Sort of kept up with her and her family for a year or so. I know they are rare, but at one point we had three in five days. Link to comment Share on other sites More sharing options...
ShaneAEMS Posted July 6, 2008 Share Posted July 6, 2008 You had no suspicion of the AA, Abd pain even on palpation,guarded position?, ever have an altered LOC? Narrowing pulses? Blood pressure needle drop 10 mmhg every beat of the heart? Pale, diaphoretic skin, and the syncope episode, I would of had either internal bleeding or maybe even AAA, but with it being a birth defect you say? I would have guessed that along those lines.... Link to comment Share on other sites More sharing options...
chbare Posted July 6, 2008 Share Posted July 6, 2008 Was it a dissection, an aneurysm, or did she have both? Take care, chbare. Link to comment Share on other sites More sharing options...
firedoc5 Posted July 6, 2008 Author Share Posted July 6, 2008 You had no suspicion of the AA, Abd pain even on palpation,guarded position?, ever have an altered LOC? Narrowing pulses? Blood pressure needle drop 10 mmhg every beat of the heart? Pale, diaphoretic skin, and the syncope episode, I would of had either internal bleeding or maybe even AAA, but with it being a birth defect you say? I would have guessed that along those lines.... It was something in the back of my mind at first, but thought about her age, no recent trauma, etc. But the second she said she had chest pain that she couldn't describe as radiating to her back, or back pain radiating to her front, I knew. I thought, "Oh, surely not". That and the narrow pulse pressure. There was no erratic movement of the BP gauge. And Chbare, it was both. Link to comment Share on other sites More sharing options...
chbare Posted July 6, 2008 Share Posted July 6, 2008 Wow, we are talking total aorta replacement. Take care, chbare. Link to comment Share on other sites More sharing options...
firedoc5 Posted July 7, 2008 Author Share Posted July 7, 2008 Wow, we are talking total aorta replacement. Take care, chbare. That's what they did. If I remember right it was some kind of new nylon replacement. At first they thought they were going to have to repair it enough to keep her from bleeding out while one would have to be delivered. But luckily surgical supply found one in-house. Link to comment Share on other sites More sharing options...
ShaneAEMS Posted July 7, 2008 Share Posted July 7, 2008 OK earlier I couldn't think of the name for the 10 drop of mmHg every beat.. pulsus pardoxus... had it off the tip of my tongue but never came out.. so do you know recent where abouts of this patient and the current state of health? Link to comment Share on other sites More sharing options...
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