Jump to content

Recommended Posts

  • Replies 49
  • Created
  • Last Reply

Top Posters In This Topic

Top Posters In This Topic

Popular Posts

So I win?!? I thought I was off track with my rhabdo comment:/

There was no compartment syndrome, just the rhabdo. As for the 'how', that is hard to say. There are no purity guidelines so who knows what it was really mixed with. http://www.ncbi.nlm.nih.gov/

Well the reference range for BUN I learned is 6-20 and Cr 0.6-1.2...I'm thinking some renal failure is going on for some reason or another...has he recently started working out? Any chance this could be rhabdo?

Link to post
Share on other sites

Ok. Let's review a bit.

We have an 18 YOM complaining of back pain for two days now. It hurts him to stand on it or sit on it.

Do we have his PMH including meds, allergies, history of smoking, drinking, drug use?

Can we please get a set of vitals?

On exam he's pale and sweaty without any signs of infection or trauma to the skin/extremity.

Lung sounds?

Heart sounds?

Abdominal pain on exam?

Back exam reveals no CVA tenderness.

Extremity exam reveals severe pain on palpation with a refusal to even move the affected leg. Bilat distal pulses present. No visible differences between bilat LE.

Neuro exam appears intact. Bowel/bladder incontinence?

Labs (Hey! We have labs in the field!) show protein and blood in his urine, renal failure (BUN/CREAT are elevated), an elevated D-dimer (from the renal failure or from something else? Hmmm...), negative extremity U/S for DVT.

Let's get this guy on the monitor. I would hope we started a line to draw the blood so let's hang some fluid. Load him up on some pain meds and roll.

Since we already have some values do we also have the CBC and the rest of the chem?

Link to post
Share on other sites

did he fall asleep on the couch in mommy's basement with the remote underneath his butt?

No remote is found upon inspection of the buttocks.

Ok. Let's review a bit.

We have an 18 YOM complaining of back pain for two days now. It hurts him to stand on it or sit on it.

Do we have his PMH including meds, allergies, history of smoking, drinking, drug use?

Can we please get a set of vitals?

On exam he's pale and sweaty without any signs of infection or trauma to the skin/extremity.

Lung sounds?

Heart sounds?

Abdominal pain on exam?

Back exam reveals no CVA tenderness.

Extremity exam reveals severe pain on palpation with a refusal to even move the affected leg. Bilat distal pulses present. No visible differences between bilat LE.

Neuro exam appears intact. Bowel/bladder incontinence?

Labs (Hey! We have labs in the field!) show protein and blood in his urine, renal failure (BUN/CREAT are elevated), an elevated D-dimer (from the renal failure or from something else? Hmmm...), negative extremity U/S for DVT.

Let's get this guy on the monitor. I would hope we started a line to draw the blood so let's hang some fluid. Load him up on some pain meds and roll.

Since we already have some values do we also have the CBC and the rest of the chem?

He has a past medical history of Ultram induced seizures about 4 years ago. Otherwise, no history or meds. He smoke 0.5ppd, no alcohol use. He has a history of heroin abuse, he last shot up over 3 months ago. He smoked some marijuana a few days ago.

Vitals: P 112, BP 157/99, RR 18, Temp 36.9 orally, 99% on room air

Lungs are clear bilat

Heart RRR, nl S1, S2, no murmur, rubs or gallops.

Abd is soft, non-tender, non-distended

No bowel or bladder incontinence

Na 132

K4.4

Cl 96

Bicarb 24

Anion Gap 12

BUN 36

Cr 2.3 (These are the correct values, the previous ones were my incorrect recollection)

Glucose 108

Ca 8.8

Mg 2.6

Phos 5.2

Total protein 8

Albumin 4

Total Bili 0.7

Alk Phos 66

AST 907

ALT 362

WBC 16.19

Hgb 16.7

Hct 46.4

Plt 225

Red denotes abnormal lab values in our system.

I don't have a rhythm strip, but I'll give you the 12-lead

EKG_zps06c1ec30.jpg

Link to post
Share on other sites

×
×
  • Create New...