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Diarrhea & Dark Leg

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 72-year-old female with a history of lung cancer and hypertension presents to the ED for 1-2 weeks of diarrhea.  She is on a stable chemo regimen that has not caused this degree of diarrhea previously.    She denies vomiting, bleeding and fever.  She has mild intermittent abdominal cramping, but no real pain.  She also mentions that her right leg has been cramping up on her on and off for about 4 days.  She denies back pain, urinary symptoms or other complaints

Vital Signs & Physical Exam:

Vital signs are normal except for a pulse of 97 (SIRS criteria has ULN pulse of 90).  BP is a bit soft.  The abdomen is benign.  Her leg is shown below

Initial Differential Diagnosis:

  • DVT
  • Cellulitis
  • Electrolyte abnormality
  • Limb ischemia

Initial Diagnostic Testing:

  • EKG: normal
  • Labs: WBC 22K, BUN/Cr 101/4.7

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows mottled skin on the right leg.
  2. What should you do next?  Order an arterial duplex of the right leg.  Consult vascular and IR.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: She went to IR for thrombolysis

CASE LESSONS:

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