Clinical Pearl: Thursday, June 7
A 45F presents with 3 weeks of CP.
Her vitals: Temp 36.8C HR 71 BP 95/65 RR 18 O2 98% RA
Her exam is unremarkable, with no signs or symptoms of DVT.
She denies hemopytsis.
She denies OCP or estrogen usage.
She denies personal hx of VTE or coagulation disorders.
She denies recent surgery.
Although the patient meets the PERC rule, a d-dimer is sent, it is positive.
A CTA Chest reveals a LUL PE.
Troponins were negative.
How can a PERC negative patient have a PE?
Clinical Pearl, Wednesday, June 6
What are the six “hard signs” of vascular injury in penetrating trauma to the extremities?
What is the significance of finding them on exam?
Thanks to Lana Friedman for the inspiration for this pearl.
17yo M presents with two days of fever, URI symptoms, and cough. Since waking this AM he also complains of pleuritic CP and diaphoresis.
His EKG is show here (click to enlarge)
His CXR was WNL
He did not improve with supportive care.
Labs were sent. His troponin level was 8.0
What is the likely diagnosis?
What is the treatment?
What is the prognosis?
Click more for answers.
Thanks to Amy for the inspiration for this pearl.
A 32yo African-American F presents with dyspnea. She is four weeks s/p C-section. Vitals are significant for tachycardia. A bedside echo reveals global reduction in contractility and LV enlargement without hypertrophy. You suspect peripartum cardiomyopathy.
What are the four diagnostic criteria?
What is the treatment for an antepartum patient? For a postpartum patient?
Click more for answers.
Thank you to Dr. Chris “This Ain’t No Simulation” Strother.
3 kids, 3 head injuries.
A) 2-month old boy, fell out of baby carriage onto top of head 30 minutes ago. No LOC, seizure, vomiting. Acting normally per mom. Abrasion on superior scalp, no palpable skull fracture, fontanelle flat.
B) 18-month old boy, healthy, fell off slide at playground (about 3 feet) onto padded surface 30 minutes ago. Brief LOC (<5 sec), no seizure. Vomited once shortly after fall. Patient awake and sitting calmly but mom says he “usually is very hyperactive this time of day”. Parietal hematoma on exam, no palpable fracture, no neuro defecit.
C) 5-year old boy. healthy, struck tree while sledding and hit head, 30 minutes ago. No LOC, seizure or vomiting. Calm, will open his eyes when you talk to him. Frontal hematoma, no palpable fracture. Moving all extremities normally.
Who goes to CT?