Even after practising for so many years, I do wonder if I'm getting any
better! 74 yo man presented as an alerted-in patient. Sudden dizziness and
near collapse at home. Paramedics had to break down the door to get in.
Their initial readings were pulse 110, blood pressure 77/56, BM 26.6 (known
T2 diabetes) sats 100% on O2. No blood evident at scene. On tramadol for leg
pain.
On arrival, he is composed and no longer dizzy but feels weak. Wants to have
bowels open. An abbreviated history shows recent (3-4 weeks) back pain with
radiation down the left leg, which he has had before and has been ascribed
to sciatica; there is pronounced sensory loss which has come on recently and
is different from previous episodes. The GP has arranged for pain team
review. Medication - tramadol, diabetes tablets. Was on warfarin for 6/12
for a DVT 18 months ago. Pale, sweaty, cool skin, hypotensive and
tachycardic. Not particularly tachypnoeic. Blood pressure 70/40 on right, 50
systolic on left about 2 minutes later. Chest clear. Abdomen soft but he
tenses a bit. Bowel sounds normal, PR normal, no bruit over either femoral.
Ultrasound of abdomen at bedside shows small calibre aorta with appearance
of odd fluttering structure across the lumen superiorly. No neurological
abnormality to swift assessment. ECG sinus tachycardia. Saline running. Any
thoughts?
PS patient details may or may not be disguised, but the clinical picture is
indicative if not precise.
Rowley.
|