Case of the Month

Case of the Month #7, Presentation

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One of the golden girls (don’t worry, not Blanche) presents to your ER after a near syncopal episode. She reports generalized weakness, but denies all other complaints.

VS (scary): HR 136, RR 25, BP 70/30. The pulse ox won’t pick up.

She has clear lungs, normal heart sounds, no leg swelling, BUT LARGE JVD.

 

As usual most accurate/first answer to the following questions wins a special prize…

1. What are your top three differential diagnoses?

2. How are you going to work-up and treat this patient?

 

 

 

 

By Dr. Andrew Grock

 

 

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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andygrock

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1 comment for “Case of the Month #7, Presentation”

  1. L.Rolston
    January 2, 2015 at 4:17 pm

    Top 3 on my differential:

    1. Tamponade due to the presence of Beck’s Triad

    2. Massive PE

    3. Inferior MI with RV infarction

    My workup for this patient would start with IV w/500ml fluid bolus, O2, monitor, 12 lead EKG and a full set of labs. If STEMI, call code H, if alterans present consider tamponade. The next thing I would do is a STAT bedside echo, looking for one of 3 things: Effusion with tamponade, D-sign or any akinetic segment of the myocardium. If effusion with evidence of tamponade present an emergent pericardiocentesis is indicated. If D-sign present I would consider thrombolytics given hemodynamic instability and presumed hypoxia given that we can’t get a reading on out pulse ox. If there was any significant segment of abnormal wall motion I would be more likely to think the patient was having an acute MI, in which case I would give 162 mg of aspirin and call a STAT cards consult.

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