Guest guest Posted February 21, 2003 Report Share Posted February 21, 2003 That would have shown on the abdominal series. Bledsoe, DO, FACEP Midlothian, TX RE: Interesting Case A volvulus with diaphramatic rupture- my total stab in the dark. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2003 Report Share Posted February 21, 2003 No Bledsoe, DO, FACEP Midlothian, TX Re: Interesting Case > > An acute appendix. > Interesting Case > > Since everybody is throwing out interesting cases, here is a case from my > internship in West Texas in 1987: > > 22 year old male with nausea and vomiting calls EMS. They administer > Phenergan and fluids and take to the ED. In the ED, his work-up is > unremarkable except a slightly elevated white blood cell count that the ED > attending felt was due to the vomiting. After 2 liters of saline and some > additional Phenergan, the patient is sent home. 30 hours later, at 3:00 > AM, > he summons EMS. He has had 12 hours of nausea and vomiting and complains > of > abdominal pain. Paramedics start another IV and transport him to the ED > > In the ED he appears toxic. His WBC is 17.6 with a left shift. His H & H is > OK. His electrolytes are normal except a BUN of 61 and a Creatinine of 1.1 > (consistent with dehydration). Liver function tests are normal. Gall > Bladder > sonogram is normal. A flat and upright abdominal x-ray is normal as is the > CXR (per the radiologist). On physical exam: > > HEENT: Mucosa dry. No icterus > > CHEST: Heart sounds diminished. Bilateral rhonchi that clear > with coughing. > > ABD: Markedly diminished bowel sounds. No bruising. No CVA or > flank tenderness. Maked left lower quadrant tenderness with a hint of > rebound. No Psoas sign. Rectal unremarkable and Hemocult negative. > > GU: Normal male. No torsion. > > EXT: Normal. Pulses equal. No edema > > NEURO: Normal. CNII-XII intact. Normal motor ands sensory. > Gait > testing painful. > > Vitals: 110/60, Pulse 130, respirations 20, Temp 100.9 F, SpO2 > 99% o 2 LPM. > > Surgeon sees patient and decides to let the illness declare itself. The > next morning, the patient is sicker and we take him to surgery and find > what? > > Bledsoe, DO, FACEP > > Midlothian, TX > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2003 Report Share Posted February 21, 2003 Another gross assumption (x-rays) that, in this case made for just something interesting. At least you were taking something out, rather than do a transplant (zing!). Must have been quite a shock when you opened the guy up. At least he can say his heart is in the RIGHT place! What is the incidence of this occuring? Or maybe he was an Alien? Larry Quote Link to comment Share on other sites More sharing options...
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