History of Present Illness: A man in his mid 70’s with COPD is brought by medics to the ER for fainting and altered mental status. He had endoscopy 4 days ago. He was walking this morning but “didn’t feel well” according to his wife. She denies him having fever, chest pain or other complaints
Vital Signs & Physical Exam: Pulse ox 99%, very tachypneic, HR 140’s, BP fine, no wheezing but some rales, tender abdomen, eyes open but not tracking or responsive. Non-focal but lethargic response to painful stimuli
Initial Diagnostic Testing:
What is the most likely diagnosis?
- A) Pneumonia
- B) CHF
- C) PE
- D) None of the above
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>
THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA
Emergency Medicine 1-Minute Consult, 5th edition
A-to-Z EM Pharmacopoeia & Antibiotic Guide, 5th edition
8-in-1 Emergency Department Quick Reference, 5th edition
******************************************************************************
<<<<<<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>>>>>>>
ANSWER:
- A) Pneumonia
- B) CHF
- C) PE
- D) None of the above – CORRECT. Free air from perforated viscus
1-Minute Consult on this topic: Click HERE and scroll to page 83.
CASE CONCLUSION: went to the OR, had large perforation of sigmoid as well as areas of bowel ischemia, survived surgery, went to ICU with abdomen left open to avoid abdominal compartment syndrome.
***