CC:
CC: 62 yo male with abdominal pain
HPI: 62 yo male presents to ED with c/o severe abdominal pain. He has had “gnawing” epigastric pain for several weeks, slightly improved with food. It has been getting more severe, esp in past 3 days. He was actually going to go to his clinic to get checked out several days ago, but b/c he could not get a ride, decided to wait until the VA bus went to Minneapolis (this is why he is coming in today). En route to the VA, the pain worsened (now rated 8/10). Pain was initially primarily in the epigastrium, but now seems more diffuse. No radiation.
Has been taking 600-900 mg of ibuprofen at least 3 times daily for chronic low back pain x one month.
ROS:
+
Nausea
Anorexia
Weight loss over past month.
Mild lightheadedness
-
Fevers, chills, sweats
Cough, dyspnea
Chest pain
Emesis, diarrhea, melena, BRBRP
Urinary sx
PMH:
Chronic low back pain
COPD
HTN
MEDS: (All: NKDA)
HCT-Z
Albuterol mdi prn
ibuprofen
SOC HX:
Lives outside of Redwing MN
Works as a farmer
Smokes 1ppd x35 yrs
Rare etoh (1-2 drinks/month)
No illicits
Sexually active with wife only
No recent travel, tick bites
Has daily contact with pigs and cows
FAM HX: unknown - adopted
PE:
Vitals: T95.6 P110 BP 113/63 RR 20 SpO2 98% RA
Gen: Elderly WM, laying still in bed, appears uncomfortable.
HEENT/Neck: PERRL, EOMI, sclera anicteric, OP clear, no LAN
CV: Tachycardic, RR, nl s1,s2 no m/r/g
Resp: CTA bilat. No wheezes/rales/rhonchi
Abd: nondistended, diminished BS, abd extremely tender to even light percussion and palpation. No rebound.
Rectal: nl rectal tone, minimal stool in rectal vault, no blood, patient c/o diffuse abd pain with exam.
Ext: no edema
Skin: no rashes or lesions
Neuro: A+Ox3
Labs (return after primary team leaves):
16.7 140 97 20
24.3>------< 312 -----I-----I-----< 185 Ca 9.4/Mg 2.1/Po4 4.7
N81, B8, L8 4.1 29 1.2
TB 0.9 INR 1.10
AP 83 Lactate 3.3 (upper normal 2.2)
ALT 22 UA sp 1.080, 30 prot, 3WBC
AST 23
On pt reassessment by the cross-covering intern, he is diaphorectic and obviously in severe pain. + rebound on exam (even slight movement of bed lead to pain).
Stat Flat and upright abd xray shows free air under the diaphragm
Emergent Surgery – perforated duodenal ulcer
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- g cc to kg m 3
- g cc to kg mm3
- piston dish cc calculator
- free photoshop cc plugins
- cc to cup conversion chart
- cc to hp conversion chart
- cc horsepower conversion chart
- briggs cc to horsepower conversion
- briggs and stratton cc to hp chart
- engine cc to horsepower calculator
- cc to horse power calculator
- 160 cc to hp conversion