ERDoc Posted February 23, 2014 Posted February 23, 2014 You are called to the residence of an 18y/o male. It is a normal middle class house in a normal middle class neighborhood. You enter to find an 18y/o male sitting in a chair trying to hold himself off his left buttock and he is visibly uncomfortable. He tells you that he woke up yesterday morning with the pain. He figured it would go away but it is much worse today. What else do you want to know?
island emt Posted February 23, 2014 Posted February 23, 2014 What type of car does he have ???? Why ::::::: you wonder? Trying to have sex in a kia or volt would cause anyone back pain. OK being serious now:: What events led up to this pain yesterday morning. Did he do any heavy lifting or other strenuous work ? Any contact sports? any prior history of similar pain? Any shortening or rotation of left leg? Any difficulty moving his left leg through full range of motion? Any protrusion or displacement of hip / pelvis? distal pulses? Any obvious injury visible? Yes we need to look at his butt cheek Abdominal exam shows????
hertzvanrental Posted February 23, 2014 Posted February 23, 2014 (edited) All the above Can he straight leg raise? Urinalysis etc etc Altered neurology (Inc the left leg), reflexes Full family hx re: cancers etc CVA tenderness Hx of recent trauma, exercise Edited February 23, 2014 by hertzvanrental
DartmouthDave Posted February 23, 2014 Posted February 23, 2014 Hello, Lets get a set of vital signs with a temperature. Plus, a little more history / PQRST plus an exam. How dose he look? Sick? A disproportionate amount of pain without an obvious injury or source is worrisome. It could be a bad soft tissue infection (i.e. Fournier Gangrene / Necrotizing Fascitis). A triple 'AAA' can present with more than back pain. For example, I once saw a fellow who only complaint was a sore left testicle. Cheers
ERDoc Posted February 23, 2014 Author Posted February 23, 2014 The pt is unemployed and dropped out of school about a year ago. He is unemployed and says, "I've just been sitting around watching TV." He's never had anything like this before. No family history. It hurts to move the leg or to stand on it. When you walk in he looks a little pale and sweaty. No signs of trauma, shortening or infection. Any palpation of the left buttock and posterior upper thigh causes him to scream in pain. He refuses to move it and will not let you move it. There are equal pulses and the color/temp are the same in each leg. No CVA tenderness. Urine has 75 protein, 250 blood, negative for nitrate and leuk est, 0-2 white and 0-2 red cells. No bacteria are seen.
medicgirl05 Posted February 23, 2014 Posted February 23, 2014 Has he been sick recently? It is possible to herniate a weak disc just with a cough or sneeze. Is he having any different sensations in the extremity? Pins and needles or numbness? Are his reflexes equal in both extremities?
ERDoc Posted February 23, 2014 Author Posted February 23, 2014 Patellar and Achilles reflexes are 2+ bilat. No change in sensation. He reports that he had a cold about 1-1.5 weeks ago.
J306 Posted February 23, 2014 Posted February 23, 2014 (edited) Could this be as simple as a pinched sciatic nerve? Can cause extreme pain to the regions the patient described. Edited February 23, 2014 by J306
HellsBells Posted February 23, 2014 Posted February 23, 2014 My first thought was that he passed out drunk and had a foreign body inserted in his rectum, Ala Jakass. However his presentation doesn't go along with that. Maybe get a D-dimer. Possible DVT from sitting around watching TV all day?
ERDoc Posted February 24, 2014 Author Posted February 24, 2014 Your rectal exam reveals no foreign bodies. The d-dimer is 750 (nl<500).
Recommended Posts