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Chest pain


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Any recent trauma? any subq air noted anywhere else? Any trauma visible anywhere? Are his psychiatric problems well controlled? What meds does he take? Is he compliant with his meds? Lung sounds, heart sounds?

Any complications with the colonoscopy? Any bleeding? Bowel movements since?

Edited by Curiosity
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No history of trauma. Subq air from umbillicus up to mandible. No signs of trauma. Psych issues under control and he is compliant with is meds (seroquil, ativan).

Lungs are clear bilat. Heart has normal s1s2, no murmurs, rubs or gallops.

The pt does not believe there were any problems with the colonoscopy. He wasn't told of any and went home as scheduled. He thinks they removed a few polyps but isn't sure. No rectal bleeding. No BMs since.

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Possibly a complication from the colonoscopy which caused a perforation which forced the air into the Mediastinum causing the subq emphysema and abdo pain?

Ok this is a scenario so I'll work it like a scenario. My next step would be evaluate his resps, make sure there's no airway compromise, IV, transport. If it is a tear in his colon, he's at high risk for infection.

Edited by Curiosity
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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.

What was he doing when the pain started?

How long between the colonoscopy and the onset of the pain?

What did they use for sedation for the procedure?

Has he eaten since the procedure?

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Possibly a complication from the colonoscopy which caused a perforation which forced the air into the Mediastinum causing the subq emphysema and abdo pain?

Ok this is a scenario so I'll work it like a scenario. My next step would be evaluate his resps, make sure there's no airway compromise, IV, transport. If it is a tear in his colon, he's at high risk for infection.

A definite possibility. How would you explain an intraabdomenal perf leading to subq emphysema up to the neck? How would the air be forced into the mediastinum?

What was he doing when the pain started?

How long between the colonoscopy and the onset of the pain?

What did they use for sedation for the procedure?

Has he eaten since the procedure?

He was sitting at home, watching TV at the onset

He was discharged about 5 hours prior to the onset

Records from the procedure are not available

He has a Cheeseburger and fried from McDs on the way home

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A definite possibility. How would you explain an intraabdomenal perf leading to subq emphysema up to the neck? How would the air be forced into the mediastinum?

During a colonoscopy, the colon is insuflated with air. A tear could cause the air to collect either in the peritoneal cavity or the retroperitoneum. From there, the air can travel up to the mediastinum (pneumomediastinum) and the neck,causing the subq emphysema. A pneumomediastinum would also explain the chest pain.

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During a colonoscopy, the colon is insuflated with air. A tear could cause the air to collect either in the peritoneal cavity or the retroperitoneum. From there, the air can travel up to the mediastinum (pneumomediastinum) and the neck,causing the subq emphysema. A pneumomediastinum would also explain the chest pain.

But how is the air able to cross the diaphragm into the chest? If the abdomenal and thoracic cavities have not been violated other than the perfed colon, how do the air go subq? Would it not be contained in the cavities by the muscular walls?

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