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Case Presentation

Case Presentation. Kelly King, D.O. ARIA Health, PGY-4 Emergency Medicine Resident. Chief Complaint. 73 y/o F with abdominal pain and vomiting. Initial Vitals. T 98.4F P 82 RR 18 BP 125/63 SaO2 94% on Room Air Weight 85.6 kg. HPI.

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Case Presentation

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  1. Case Presentation Kelly King, D.O. ARIA Health, PGY-4 Emergency Medicine Resident

  2. Chief Complaint • 73 y/o F with abdominal pain and vomiting

  3. Initial Vitals • T 98.4F • P 82 • RR 18 • BP 125/63 • SaO2 94% on Room Air • Weight 85.6 kg

  4. HPI • 73 y/o F presents to ED via EMS secondary to abdominal pain x 2 days • “it hurts”

  5. Review of Symptoms • Not able to assess due to mental status

  6. PMHPSH • Anxiety Disorder • Hypothyroidism • High Cholesterol • Cholecystectomy

  7. Social History • Current every day smoker

  8. Home Medications • Altoprev ER 60 mg daily • Percodan 325 mg/4.8355 mg two times daily • Lexapro 10 mg daily • Lorazepam 2 mg four times a day • Meloxicam 15 mg daily • Synthroid 150 mcg daily

  9. Physical Exam • General Appearance: Well nourished, pt appears ill • Eyes: PERRL, EOMI, clear conjunctiva B/L • Oropharynx: no exudate, no erythema, no airway obstruction • ENMT: dry oral mucosa, normal color • Neck: no JVD, supple

  10. Physical Exam • Cardiac: regular rhythm, normal rate, no gallop, no murmur, no rubs • Respiratory: normal respiratory effort, no tenderness to palpation, no crepitus • Lung: Diffuse coarse breath sounds B/L, no wheezing, rales or rhonchi • Rectal: trace heme positive, empty rectal vault

  11. Physical Exam • Abdomen: Hyperactive bowel sounds, (+) diffuse tenderness, (+) guarding, (+) rebound, non-distended and soft, normal turgor, normal color, warm, dry • Lower extremities: Poor hygiene of feet • Back: full ROM, non-tender, no CVA tenderness • Mental status: awake, disoriented • Neuro/psych: patient moving all 4 extremities

  12. EKG • Photo

  13. Laboratory Data

  14. Laboratory Data • PT/INR: 24.7/2.2 • PTT: 31 • Troponin: < 0.02 • UA: Moderate blood • 80 ketones • 100 protein • Blood Type: A- Ca: 8.4 Total Bili: 0.1 Direct Bili: < 0.1 Total Protein: 6.8 AlkPhos: 57 AST: 17 ALT: 17 Lactic Acid: 1.1

  15. ED Course • Seen by ED Physician • Patient having tonic-clonic seizure • Sepsis alert called • Pt intubated due to increased agitation and need for airway protection and further diagnostic studies

  16. Portable Chest XRay

  17. CT A/P with Oral & IV Contrast • Picture

  18. CT A/P with Oral & IV Contrast • Picture

  19. CT Brain • Photo

  20. Faculty Discussant

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