Aortic dissection.
> On 16 May 2014, at 6:55, Rowley Cottingham <[log in to unmask]> wrote:
>
> 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.
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