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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

Case Presentation

Kelly King, D.O.

ARIA Health, PGY-4

Emergency Medicine Resident


Chief complaint

Chief Complaint

  • 73 y/o F with abdominal pain and vomiting


Initial vitals

Initial Vitals

  • T 98.4F

  • P 82

  • RR 18

  • BP 125/63

  • SaO2 94% on Room Air

  • Weight 85.6 kg


Case presentation

HPI

  • 73 y/o F presents to ED via EMS secondary to abdominal pain x 2 days

  • “it hurts”


Review of symptoms

Review of Symptoms

  • Not able to assess due to mental status


Pmh psh

PMHPSH

  • Anxiety Disorder

  • Hypothyroidism

  • High Cholesterol

  • Cholecystectomy


Social history

Social History

  • Current every day smoker


Home medications

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


Physical exam

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


Physical exam1

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


Physical exam2

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


Case presentation

EKG

  • Photo


Laboratory data

Laboratory Data


Laboratory data1

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


Ed course

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


Portable chest xray

Portable Chest XRay


Ct a p with oral iv contrast

CT A/P with Oral & IV Contrast

  • Picture


Ct a p with oral iv contrast1

CT A/P with Oral & IV Contrast

  • Picture


Ct brain

CT Brain

  • Photo


Faculty discussant

Faculty Discussant


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