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 12/14/2009
A 75 year old male with a history of frequent falls, a-fib (on Coumadin), CVA (on plavix) and CAD (on ASA and lopressor) presents to the ED with a trip and fall that occurred 2 hours prior to presentation. The fall was witnessed: there was no bowel or bladder incontinence, seizure like activity or biting of the tongue. The patient did lose consciousness for about one minute. When the patient woke, he was unable to walk and was confused. In the ED, the patient is A+OX1 (baseline he is oriented to person, place and time) and moving all four extremities. He is cooperative. He has multiple abrasions and a large left sided parietal contusion. You rush him to CT scan of the head and C-spine (since you have been reading our visual stims). Immediately after the CT the pt is non-responsive and the left pupil is 8mm and the right pupil is 4mm. His HR: 45 and BP:240/100. What is your diagnosis?
