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ER case conference

ER case conference. 報告者：溫聖辰. Patient profile. Chart No.: 14722060 Name: 巫 X 緯 Gender: male Age: 18 Date of visiting: 19:04,May 3, 2007. Status on arrival. Conscious : clear, E4V5M6 vital signs : Temperature: 37.0 ℃ Pulse: 68 bpm Respiratory rate: 24 cpm

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ER case conference

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  1. ER case conference 報告者：溫聖辰

  2. Patient profile • Chart No.: 14722060 • Name: 巫X緯 • Gender: male • Age: 18 • Date of visiting: 19:04,May 3, 2007

  3. Status on arrival • Conscious : clear, E4V5M6 • vital signs : • Temperature: 37.0 ℃ • Pulse: 68 bpm • Respiratory rate: 24 cpm • Blood pressure: 130 / 79 mmHg

  4. Chief complaint • Chest pain started since around 12 o’clock

  5. Present illness • This 18-year-old male denied any systemic disease. • Chest pain was attacked to him at 00:00 , May 3, 2007 • Description of the pain • Location: left chest • Duration: persist • Frequency: ? • Onset: Sudden onset • Character: compressive pain • Aggravating factor: breathing • Relieving factor: changing position • Radiatoin: shoulder • Other associated symptoms and sign:cold sweating (-), mild dyspnea. • Due to above reasons, he was brought to ER for medical aid at 19 o’clock on May 3, 2007.

  6. Past history • Asthma(-) • Drug allergy (-) • Admission history: • Acute pharyngotonsilitis [87/08/22~25] • cc: intermittent fever with leukocytosis on 8/10 • Admitted to pediatric ward.

  7. Physical examination • Body weight:60Kg • Consciousness: E4M6V5 • Vital sign: • BP: 130/79, PR: 68bpm, T: 37℃, RR: 24 times/min • Head • Conjunctiva: • Sclera: • Oral mucosa: • Neck: Supple, LAP ( ) JVE ( ) • Chest: • Crepitus was found around both clavicular area. • Breathing sound: decreased over left upper lung field • Chest sono: no occult pneumothorax • Heart sound: • Abdomen: • Bowel sound • Palpation • Percussion • Extremities:

  8. 5/3 00:00 Chest pain occurred 19:04 Arrival on KMUH ER - conscious clear, vital signs stable - Chest PA. - on O2 2l/m Blood exam Chest CT non-enhanced NPO N/S 1BT Stin 1vial + Aqdest 1 amp 19:45 20:35 R/O spontaneous pneumomediastinum  Chest CT. 21:40 22:20 BP: 111/65 ; P:54 ; SpO2:100% BP: 130/70 ; P:63 ; BT:36.8; SpO2:100% 23:45 BP: 108/63, consciousness : clear

  9. 5/3 23:55 Sign permit Bronchoscopy Keep NPO Transferred to Thoracic surgery ward Admitted to Pediatric surgery ward 5/4 00:30 BT: 36.2 ; BP:110/64 ; P:62bpm ; SpO2:99% Consciousness : clear 5/4 01:30

  10. Diagnosis • Spontaneous pneumomediastinum, • Pericardial and extensive subcutaneous emphysema.

  11. Management an follow up • Admitted to thoracic surgery • Esophagogram was done and revealved no extravasion of contrast • Empiric antibiotics were given • Cefazolin + Gentamycin • Chest PA was followed and condition improved • MBD and OPD follow up.

  12. Esophagogram

  13. Esophagogram No contrast extravasation from the esophagus in this study.

  14. Thanks for your attention

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