Scenario - Found Somewhere

[TTLWHKR]

Scenario

23 y/o Male Patient

States he had a sudden, dull pain in his back, just below the shoulder blades; almost like he was struck with a blunt object. Pain went away with in a few seconds, during the time he felt the pain, he had sudden SOB, and inability to inhale; and suffered a momentary loss of consciousness. After pain subsided, he began to have mid-sternal chest pain that recur at regular intervals. Heart rate in the mid 80's, respiratory rate 20, bp 120/80. No history, and takes no medications. When pain begins, heart rate can vary anywhere from 90 to 140. BP elevates to around 140/90. resp rate remain the same. Other than slight tachycardia with pain, EKG shows normal sinus rhythm. O2 Sat 96% on room air. No sign of injury, at the time the pain began, patient was walking at a slow pace. No diaphoresis; skin is warm & pink.

What could be wrong?

 

[Summit]

no trauma hx?

beats me. acid reflux and something else maybe? load him up, high flow O2, call PA or ALS (b/c i have no idea whats wrong with em)

 

[Wingnut]

Originally posted by Blueeighty8@Mar 13 2005, 03:12 AM
and suffered a momentary loss of consciousness.

This is the part that's getting me...

Ok I'm a n00b but I gotta guess...sooo at 23 y/o, I'd say trauma (playing football or something and didn't realize he'd hurt himself...broken rib maybe?


My creative guess...

Post-op trans gender female...having silent MI.

 

[TTLWHKR]

Originally posted by Wingnut@Mar 13 2005, 10:10 PM


Post-op trans gender female...having silent MI.

:blink:

Um. No.

Maybe, minor trauma, fall from standing height-backward onto the ground. Several weeks prior to incident.

That's all I have. People don't reply to the thing I "borrowed" it from very often.

 

[rescuecpt]

If he was tall and thin (or just thin) I say spnontaneous pneumothorax.

 

[EMTstudent]

Okay, student talking here...


Pulmonary Embolism ??? :unsure: :unsure: :unsure:

 

[Summit]

Originally posted by rescuecpt@Mar 14 2005, 12:53 AM
If he was tall and thin (or just thin) I say spnontaneous pneumothorax.

I shoudl have thought of that. But the LOC?

What were the breathsounds?

 

[Wingnut]

If it's a spontaneous pneumothorax I think they can go up to a few days before they become hypoxic? So LOC could be normal.


I cheated and looked through my book, I'm with this conclusion too.

 

[Jon]

Ok - I'm REALLY scratching my head, but here is my differiantal Dx. List.

PE
MI
Blood clot somewhere else in cardiothoratisc cavity
Spontanious Pneumo


NO friggin' clue


Jon

 

[TTLWHKR]

Response from poster on original site:
Bulging disc, possibly caused by severe coughing due to bronchitis, Lung sounds scratchy bi/lat bases. Hx of narrowing of the spinal canal causing momentary loss of sensation to the area of the diaphram. Some pain in areas above and below w/ point tenderness above the affected area, no swelling. All pain subsided w/ in 24 hours. LOC could have been a response to the feeling of not being able to inhale or exhale, i.e. panic attack. Midsternal pain, below the xyphoid process, possible nerve response due to disc herniation in that area. Occasional numbness in left hand. All vitals stable, no respiratory difficulty. Symptoms gone w/ in 24 hours.


who knows.

 

[EMTstudent]

Originally posted by Blueeighty8@Mar 14 2005, 08:46 PM
Response from poster on original site:
Bulging disc, possibly caused by severe coughing due to bronchitis, Lung sounds scratchy bi/lat bases. Hx of narrowing of the spinal canal causing momentary loss of sensation to the area of the diaphram. Some pain in areas above and below w/ point tenderness above the affected area, no swelling. All pain subsided w/ in 24 hours. LOC could have been a response to the feeling of not being able to inhale or exhale, i.e. panic attack. Midsternal pain, below the xyphoid process, possible nerve response due to disc herniation in that area. Occasional numbness in left hand. All vitals stable, no respiratory difficulty. Symptoms gone w/ in 24 hours.


who knows.

I knew that... :lol:

 

[Jon]

bizzare.

jon

 

[Wingnut]

Damn they never gave us that one in class...

 

[Summit]

Oh.... coughing now?

My guess for LOC is now cough syncope (not that uncommon... happened to W bush last year)

 

[Phridae]

Originally posted by Blueeighty8@Mar 14 2005, 08:46 PM
Response from poster on original site:
Bulging disc, possibly caused by severe coughing due to bronchitis, Lung sounds scratchy bi/lat bases. Hx of narrowing of the spinal canal causing momentary loss of sensation to the area of the diaphram. Some pain in areas above and below w/ point tenderness above the affected area, no swelling. All pain subsided w/ in 24 hours. LOC could have been a response to the feeling of not being able to inhale or exhale, i.e. panic attack. Midsternal pain, below the xyphoid process, possible nerve response due to disc herniation in that area. Occasional numbness in left hand. All vitals stable, no respiratory difficulty. Symptoms gone w/ in 24 hours.


who knows.

I was just about to say that. h34r:

 

[EMTstudent]

Originally posted by Phridae+Mar 15 2005, 03:51 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (Phridae @ Mar 15 2005, 03:51 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-Blueeighty8@Mar 14 2005, 08:46 PM
Response from poster on original site:
Bulging disc, possibly caused by severe coughing due to bronchitis, Lung sounds scratchy bi/lat bases. Hx of narrowing of the spinal canal causing momentary loss of sensation to the area of the diaphram. Some pain in areas above and below w/ point tenderness above the affected area, no swelling. All pain subsided w/ in 24 hours. LOC could have been a response to the feeling of not being able to inhale or exhale, i.e. panic attack. Midsternal pain, below the xyphoid process, possible nerve response due to disc herniation in that area. Occasional numbness in left hand. All vitals stable, no respiratory difficulty. Symptoms gone w/ in 24 hours.


who knows.

I was just about to say that. h34r: [/b][/quote]
I knew it before you did

:lol: :lol: :lol: