HighHopes
Forum Senior
Topics: 12
Posts: 165
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healthy 65 yo man brought in ER after 40 min sudden SOB. no past medical history available.HR 120, BP 90/60, RR 25. exam JV distention, lung clear , heart s4. no edema.
ABG: PH:7.5
PCO2: 16 mmHg
PO2 :64 mmHg
Diagnosis?
1- Aortic valve rupture
2- Cadiac tamponad
3- PE
4-CHF
5- Sepsis
6-Pneumonia
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| foucesed doc
Forum Senior
Topics: 14
Posts: 78
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PE
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| adej
Forum Newbie
Topics: 0
Posts: 3
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differential dignosis?
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| aml
Forum Senior
Topics: 5
Posts: 132
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PULMONARY EMBOLISM
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| AAzad
Forum Guru
Topics: 57
Posts: 460
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FOR 1-2-4-5-6- I HAVE RESON TO R/O.
PE SEEMS CORRECT ALSO TEMP, IS MISSING
___________________
AAzad
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| chemamr
Forum Hero
Topics: 703
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i think i know the answer but i want to ask you:
how did you rule out cardiac tamponade??
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| HighHopes
Forum Senior
Topics: 12
Posts: 165
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PCO2: 16 mmHg
PO2 :64 mmHg
I don't think you can see this blood gas disturbance in cardiac tamponad.
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| AAzad
Forum Guru
Topics: 57
Posts: 460
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I could not completly R/O tamponade but here we do not have edema and also we have S4
symp. of Tamponade:
Anxiety , restlessness
Discomfort, sometimes relieved by sitting upright or leaning forward.
--------->Difficulty breathing
-------->Rapid breathing
Fainting , light-headedness
Chest pain Radiating to the neck, shoulder, back or abdomen
Sharp, stabbing Worsened by deep breathing or coughing
-------------->Swelling of the abdomen or other areas
Skin pale, gray or blue
------>Palpitations
Additional symptoms:
---------------->Pulse, weak or absent
Drowsiness
Dizziness
------------------>Low blood pressure ( I accept 90/60 as low for this case)
Echocardiogram is first choice to help establish the diagnosis. The heart will often sound uncharacteristically faint during examination with a stethoscope. (NOT S4)Peripheral pulses may be weak or absent. Neck veins may be distended but the blood pressure may be low.
pulsus paradoxical
Fluid in the pericardial sac may show on:
Chest x-ray
Echocardiogram
Chest CT or MRI of chest
Coronary angiography (may show other changes also)
ECG changes include low voltage wave forms
___________________
AAzad
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