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Posted

Despite 1C's best attempts to bury our pt before he has dies, we get him to the hospital. What kind of testing are we going to do? What is our working differential (besides pericarditis)?

Posted

Let's start with an EKG, abdominal films and PA & lateral chest films. This is leading to wanting a chest and abdominal CT. Most radiologists with whom I have experience working don't like to do the CT without plain films first.

As for blood work a CBC and Chem panel for now to establish a baseline. I'm sure I'll think of more.

Posted

I'm still going with pneumomediastinum. I'm trying to figure out the exact mechanism of this from a perf bowel but I'm having a tough time with it. Here's what I got:

The reason is anatomical spread through the retroperitoneal fascial compartment, which extends through the posterior mediastinum to the neck.

Posted
Looks like a lot of air under that diaphragm.

What color does bone show up as on x-ray? Think picture negative for areas of hypo/hyper density.

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Posted (edited)

I'm not sure what you're driving at. It looks like free air under the diaphragm. In fact, I'm going to call it a bilateral pneumoperitoneum.

ETA: My guess is that it's probably from a perforated colon resulting from the colonoscopy this patient had earlier in the day.

Edited by paramedicmike
Posted

You are correct Mike. The guy had a perf resulting in pneumoperitoneum. Now, can you explain how he developed subq emphysema that made it's way all the way up to his neck? He has no pneumothorax or pneumomediastinum.

Posted
I'm not sure what you're driving at. It looks like free air under the diaphragm. In fact, I'm going to call it a bilateral pneumoperitoneum.

ETA: My guess is that it's probably from a perforated colon resulting from the colonoscopy this patient had earlier in the day.

More a little nudge in the right direction for anyone who has trouble understanding what they're looking at with an x ray.

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