23 yo female p/w one week h/o dyspnea with exertion and increasing lower extremity edema. Pt c/o intermittent episodes of atypical chest tightness and pressure that does not occur necessarily during rest or with exertion. Non-radiating. Does not occur with palpation, shortness of breath, nausea/vomtting or diaphoresis. Dyspnea not present at rest. Pt denies PND, fevers, cough or syncopal episodes. No recent long plane flights or car rides. Denies tobacco, alcohol or drugs. No recent changes in medication. Symptoms have been getting progressively worse over past one week. Pt now unable to climb stairs in apartment without resting mulitple times. Leg swelling is equal bilateral. No redness, warmth or pain. LMP one week ago. Her PE is significant for the following She is in NAD with normal vitals, well appearing, resting comfortably with mild b/l basilar crackles, no wheeze; has an audible murmer III/VI ASB and has b/l +1 pitting edema up to mid calf, no redness, warmth, negative homan’s sign. Below is her ECG. What is your diagnosis?
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Posted on 02/12/2010
An 8 year old female patient presents to the ED brought in by the mother who claims that the patient had been complaining of a sore throat for the past 3 days. Today she developed a fever and refused to eat. The child is tired and sleepy in triage, and is noted to be drooling. The patient refuses to open her mouth for a temperature. Her vitals are: Tr:103, HR:130, R:30, POX 100%. You note her to be sleepy but arousable, consolable by mother, and confirm that she is drooling. On pharyngeal exam, the patient refuses to open her mouth, you palpate fullness of the neck with right sided torticollis, anterior cervical LAD, note rhinorrhea, and mild stridor. Without further upsetting the child you smartly get a lateral soft tissue of the neck. What is your diagnosis? What is your next steps in managing this patient?
