Case of the Month #8, Presentation

by andygrock • February 6, 2015 • 2 Comments

CC: A 60 yo Abe Simpson (father of homer) with a past medical history of htn and anxiety presents to your ED for severe epigastric abdominal pain…

HPI: While straining during a bowel movement earlier, the patient suddenly vomited – large volume, non-bloody, nonbilious. After vomiting, he had sudden onset of severe epigastric pain, radiating to the chest, lightheadedness, anxiety, and dyspnea. After ten minutes without improvement, he calls 9-11 and comes into your ED. His symptoms continue to be constant and severe.
He denies chest pain, cardiac disease, pe or dvt risk factors, change in exercise tolerance, and any symptoms before the incident.

Vital Signs: 147/72, HR 102, RR 25, temp 98.9, o2 sat 92% on room air

PE: obese male anxious in distress.

Cardiac- normal pulses no JVD, normal S1,S2

Pulm- decreased L base, tachypnic, difficult to auscultate.

Abd- obese, soft, nondistended, mild epigastric tenderness, + Bowel sounds

After IV access and oxygen, the ECG is unremarkable and you send off a full set of labs.

CXR

On re-evaluation after morphine, esomeprazole, and odansetron, he actually looks worse.

Answer the following questions for a chance at a BIG prize.

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By Dr. Carl Alsup and 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

Resident Editor In Chief of blog.clinicalmonster.com.
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Resident at Kings County Hospital