ERDoc Posted October 11, 2012 Author Share Posted October 11, 2012 Despite 1C's best attempts to bury our pt before he has dies, we get him to the hospital. What kind of testing are we going to do? What is our working differential (besides pericarditis)? Link to comment Share on other sites More sharing options...
paramedicmike Posted October 11, 2012 Share Posted October 11, 2012 Let's start with an EKG, abdominal films and PA & lateral chest films. This is leading to wanting a chest and abdominal CT. Most radiologists with whom I have experience working don't like to do the CT without plain films first. As for blood work a CBC and Chem panel for now to establish a baseline. I'm sure I'll think of more. Link to comment Share on other sites More sharing options...
Curiosity Posted October 11, 2012 Share Posted October 11, 2012 I'm still going with pneumomediastinum. I'm trying to figure out the exact mechanism of this from a perf bowel but I'm having a tough time with it. Here's what I got: The reason is anatomical spread through the retroperitoneal fascial compartment, which extends through the posterior mediastinum to the neck. Link to comment Share on other sites More sharing options...
paramedicmike Posted October 11, 2012 Share Posted October 11, 2012 I like the perfed colon idea, too. I'll also include a pneumo along with the differential list. Link to comment Share on other sites More sharing options...
ERDoc Posted October 11, 2012 Author Share Posted October 11, 2012 Here is your chest xray Link to comment Share on other sites More sharing options...
paramedicmike Posted October 12, 2012 Share Posted October 12, 2012 Looks like a lot of air under that diaphragm. Link to comment Share on other sites More sharing options...
rock_shoes Posted October 12, 2012 Share Posted October 12, 2012 Looks like a lot of air under that diaphragm. What color does bone show up as on x-ray? Think picture negative for areas of hypo/hyper density. Sent from my SGH-T989D using Tapatalk 2 Link to comment Share on other sites More sharing options...
paramedicmike Posted October 12, 2012 Share Posted October 12, 2012 (edited) I'm not sure what you're driving at. It looks like free air under the diaphragm. In fact, I'm going to call it a bilateral pneumoperitoneum. ETA: My guess is that it's probably from a perforated colon resulting from the colonoscopy this patient had earlier in the day. Edited October 12, 2012 by paramedicmike Link to comment Share on other sites More sharing options...
ERDoc Posted October 12, 2012 Author Share Posted October 12, 2012 You are correct Mike. The guy had a perf resulting in pneumoperitoneum. Now, can you explain how he developed subq emphysema that made it's way all the way up to his neck? He has no pneumothorax or pneumomediastinum. Link to comment Share on other sites More sharing options...
rock_shoes Posted October 12, 2012 Share Posted October 12, 2012 I'm not sure what you're driving at. It looks like free air under the diaphragm. In fact, I'm going to call it a bilateral pneumoperitoneum. ETA: My guess is that it's probably from a perforated colon resulting from the colonoscopy this patient had earlier in the day. More a little nudge in the right direction for anyone who has trouble understanding what they're looking at with an x ray. Sent from my SGH-T989D using Tapatalk 2 Link to comment Share on other sites More sharing options...
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