What does the CXR show? In particular any mediastinal widening or
pneumomediastinum?
? aortic dissection
? mediastinitis/sepsis secondary to Boerhave's
Damien Ryan
SpR Emergency Medicine
Cork University Hospital
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Jel Coward
Sent: 27 February 2008 01:49
To: [log in to unmask]
Subject: Clinical problem
Hi all
Mid 40's female, seen a few days before the presentation described, with
D+V that her children also had.
Had been drinking Gatorade and water - but the last day just water -
hardly eaten anything.
Day before the presentation described - felt much better in the morning but
at lunchtime felt chilled/sweaty and not so good in the afternoon.
Presents at 7 am feeling unwell, bifrontal headache (also present for a few
days), low back pain (possibly on and off for months.
Possible FH of IHD
PMH - nil significant.
OE P 124 sinus tachy, BP 76/38 O2 sat 100percent. Pale extremities and
cool. Afebrile.
HS normal. No signs of DVT. Chest clear but RR 28. Abdo unremarkable.
Neuro nil gross but co-operation difficult as some headache and a bit
distressed. No neck stiffness. Possibley some photophobia in that vague
sort of way that seems to exist sometimes but might just be wanting to
check out of the hassles.
Limited labs available.
WCC normal, Na 126 Glucose 7.6
An hour and a half in mentions chest pain (had been asked, I think) -
started 3 am, at worst at 7am - then went away - but now recurring and BP
falls when it comes. Is retrosternal, no radiation, not tearing.
Chest pain recurs a few times over an hour or so and BP drops further every
time and then recovers to around the above level.
ECG - Sinus tachy with ST elev V1-3 and depression V5,6 (not sure of else)
Pathology?
What to do?
--
Jel
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