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Old 03-27-2012, 11:02 AM   #31
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Im thinking AAA also just because of the mass. Did you notice if it was pulsating at all?


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Old 03-27-2012, 10:53 PM   #32
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*facepalm* I bet $10 the guy had an umbilical hernia totally unrelated to anything going on. That is the only thing I can think of that would be in that spot and would show up when sitting up and disappear when lying down.


And when was the last time anyone heard of a patient with an SpO2 of 94% and non-localized cyanosis?
I don't see how they got a decent SpO2 on this patient to begin with, considering the lack of peripheral pulses, unobtainable pressure, and obvious shunting away from the periphery.
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Old 04-11-2012, 03:12 AM   #33
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Not an AAA, but rather a rupturing thoracic aneurysm. With a thoracic aneurysm it is not uncommon to get upper limb cyanosis, just like an AAA can cause lower limb cyanosis. The difficulty breathing sounds like referred pain and an attempt to "self splint" by decreasing chest wall movement. I had a patient a few years ago that exactly matches the description of this patient and a postmortem revealed an aneurism that began at the aortic arch and descended past the diaphragm.

And who was it earlier that questioned the use of high flow O2? Really? When a patient looks like crap, give them the extra fuel. The whole issue of using lower amounts of O2 pertains mainly to prolonged use and stable ACS or COPD patients, remember that you should never withhold O2 if they're really sick. You don't look smart when you do that, it just shows that you haven't truly read the research about what you're preaching.
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Old 04-11-2012, 07:13 AM   #34
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And who was it earlier that questioned the use of high flow O2? Really? When a patient looks like crap, give them the extra fuel. The whole issue of using lower amounts of O2 pertains mainly to prolonged use and stable ACS or COPD patients, remember that you should never withhold O2 if they're really sick. You don't look smart when you do that, it just shows that you haven't truly read the research about what you're preaching.
Right, high flow O2 makes all the difference for hypemic issues because the oxygen carrying capacity of plasma is so great ...

If you truly have a ruptured abdominal aneurysm to the point of exangunation you'd likely only have a distended, rigid abdomen due to the amount of peritoneal irritation. A ruptured thoracic aneurysm is more likely but my money is on PE.
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Old 04-11-2012, 08:57 AM   #35
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I still want to see the 12-lead

As far as listening for an apical pulse you could but if you can't find a carotid pulse the guy isn't perusing his brain so I doubt it's going to matter much. Might be viable for organ donation but with the shunting I'm not sure the organs would be viable anyways...
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Old 04-11-2012, 03:19 PM   #36
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I still want to see the 12-lead .
I looked for it when i came back to work and realized fire used their monitor, its saved on their LP15... In other words its gone, sorry.
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Old 07-18-2012, 05:35 PM   #37
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I know this thread is a couple of months old so don't yell at me for reviving it but I am really interested in this scenario.

While I don't have the experience yet to really offer a guess I have noticed that no one has keyed on the fact that the patient was playing Racket ball prior to onset of symptoms.

Is it possible that the patient took a hit to the chest by the ball? That would be enough of blunt force trauma to cause a pericardial tamponade (sp?) I would think.

Having played racket ball myself I know those hard rubber balls can really get moving. I've seen players get broken bones from those balls.
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Old 07-18-2012, 05:56 PM   #38
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...I have noticed that no one has keyed on the fact that the patient was playing Racket ball prior to onset of symptoms.

Is it possible that the patient took a hit to the chest by the ball? That would be enough of blunt force trauma to cause a pericardial tamponade (sp?) I would think.
Actually, someone did bring that up:

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Halfway through reading this my idea was PE, then it changed to a witnessed AAA, and now I am some what torn between the two (hahah torn.. ). He was playing racket ball earlier.. might have gotten hit in the chest causing a dislodge of plaque going into his lung causing a chain reaction and death.
I'm really intrigued by this scenario too, but unfortunately, I don't think we will ever know because we don't have access to any records other than the first-hand experience provided. Really, I think only an autopsy could be definitive.
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Old 07-18-2012, 08:07 PM   #39
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Problems with coarctation of aorta/dissection
Saddle embolus?

Murder and a fake story

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Old 07-18-2012, 08:39 PM   #40
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Was he in chronic A fib or was this new onset? Any current medications, particularly any Anticoags? Not with this situation but with symptoms after physical activities it always keep spontaneous pnuemo --> tension pneumo in the back if my mind.


Blue from the clavicles up....Line of demarcation?

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