Triage: Altered after syncopal episode. No chest pain or SOB.
History of Present Illness: A man in his mid 70’s with COPD is brought by medics to the ER for fainting and altered mental status. He had endoscopy 4 days ago. He was walking this morning but “didn’t feel well” according to his wife. She denies him having fever, chest pain or other complaints
Vital Signs: Pulse ox 99%, very tachypneic, HR 140’s, BP fine
Physical Exam: No wheezing but some rales, tender abdomen, eyes open but not tracking or responsive. Non-focal but lethargic response to painful stimuli. Babinski negative bilateral
Initial Diagnostic Testing:
What is the most likely diagnosis?
- A) Pneumonia
- B) CHF
- C) PE
- D) None of the above
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>
THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA
- Emergency Medicine 1-Minute Consult, 5th edition
- A-to-Z EM Pharmacopoeia & Antibiotic Guide, 5th edition
- 8-in-1 Emergency Department Quick Reference, 5th edition
******************************************************************************
<<<<<<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>>>>>>>
ANSWER:
- A) Pneumonia
- B) CHF
- C) PE
- D) None of the above – CORRECT. Free air from perforated viscus
1-Minute Consult on this topic: Click HERE and scroll.
CASE CONCLUSION: went to the OR, had large perforation of sigmoid colon as well as areas of bowel ischemia, survived surgery, went to ICU with abdomen left open to avoid abdominal compartment syndrome.
***