by Adam HerbstrittA female in her 20s has had recurrent presentations over the years, usually in clusters every 6 months or so.
Her only proven PMH is a previous OGD showing a small healed ulcer. She has been labeled as ‘seeking opiates’ on HAS… HPC: vomiting+++ hourly for days. She was admitted under general surgery with similar symptoms last week but self discharged on symptoms resolution. No clear cause had been identified. She now represents as symptoms returned+++ over 24 hours. Has been making periodic trips to the water fountain in ED, and appears to be inducing emesis back in the cubicle. Vitals all normal, exam unremarkable other than some upper ado tenderness without guarding. Bloods awaited. Thoughts? A middle aged male patient presents to Emergency Department following a brief severe retrosternal pain which has now resolved. He's currently undergoing chemotherapy and radiotherapy for esophageal cancer. When you see him, he's pain free, afebrile and reasonably well appearing with an unremarkable clinical exam
All kinds of scary differentials raise their head: Radiation oesophagitis, mediastinitis, oesophageal rupture, radiation pericarditis , pleural effusion, PE, aortic dissection, ACS, severe reflux / gastritis to name but a few... In the end, his chest Xray is normal, his bloods show (borderline) neutropenia with no evidence of sepsis, and he goes home, advised to keep an eye on his temperatures. A few days later his blood cultures grow Clostridium Ramosum. What is it? Is it a contaminant? Does it matter? So while evading a piece of runaway machinery, this gent fell over a wall and landed heavily on his left shoulder. Shoulder and scapula views were ordered. What's he done? Just as importantly, when does this need more than than just time in a sling and physio....?
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The Derrifoam BlogWelcome to the Derrifoam blog - interesting pictures, numbers, pitfalls and learning points from the last few weeks. Qualityish CPD made quick and easy..... Archives
October 2022
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