In case you didn’t encounter a patient with sharp inter scapular pain today!
A 67-year-old male patient presented with sharp interscapular pain. BP: 189/107 mmHg, HR: 118 bpm, RR: 26/min, T: 37, SpO2: 93% in room air. He has a history of hypertension and diabetes mellitus. The chest x-ray is shown below.
Let’s remember findings of aortic dissection in the chest x-ray.
- Depression of the left mainstem bronchus
- Displaced intimal calcification
- Indistinct or irregular aortic contour
- Left apical pleural cap
- Opacification of the “AP window” (i.e., clear space between the aorta and the pulmonary artery)
- Pleural effusion (left > right)
- Tracheal or esophageal deviation
- Widened aortic knob or mediastinum (present in only 63% and 56% of patients with type A and type B dissections, respectively)
In case you didn’t encounter an elderly with abdominal pain today!
A 72-year-old male patient presented with mild abdominal pain. BP: 145/68 mmHg, HR: 83 bpm, RR: 16/min, T: 37, SpO2: 98% in room air. He has a history of hypertension and diabetes mellitus around 25 years. On the exam, you appreciated a pulsatile mass and checked for the aorta with bedside ultrasound. Here is the cine record of the patient.
What is your next action?
Feel free to give your answers at the comment box below.
A 56-year-old male presented to the emergency department with sudden onset of severe tearing chest pain radiating to the back. He had a history of hypertension and hyperlipidemia. He was a smoker. Upon arrival, he appeared to be diaphoretic and in severe pain. He denied any prior history of chest pain. He had been without any infective symptoms lately. He was compliant with his medications, namely, amlodipine and simvastatin. At triage, his blood pressure was noted to be 80/60 mmHg with a pulse rate of 130 bpm. His oxygen saturation was 95% on room air, and his respiratory rate was 22 breaths per minute. On examination, he had muffled heart sounds, jugular venous distention, and radio-radial pulse delay.
Abdominal Aortic Aneurysm (AAA)
Lit Sin Quek
A 75-year-old obese man comes to the emergency department. He has history COPD, hypertension. He is a smoker and on regular follow-up with primary care. He describes sudden onset severe flank and back pain for past 2 hours. He denies any chest pain or dyspnea. He informs the physician about his chronic abdominal pain. His initial vital signs are HR 98 bpm, RR 24/min, BP 190/105 mmHg, T 36.9C. His examination revealed mild abdominal pain without rigidity or rebound tenderness. Bedside ultrasonography performed and the result is shown on the side.