Index of Suspicion
| Autor: | Tony, Tarchichi, Kristen, Wong, Marisa M, Fisher, Pablo, Palomo, Fernando, Zapata, Erawati V, Bawle |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Respiratory rate Physical examination Palpation Diagnosis Differential Methylamines Heart rate medicine Humans Right Thigh Gastrointestinal Neoplasms Femur fracture Muscle Weakness medicine.diagnostic_test business.industry Infant Newborn Anticoagulants Hematochezia Surgery Stroke Odorants Pediatrics Perinatology and Child Health Female medicine.symptom Gastrointestinal Hemorrhage Hemangioma Range of motion business Metabolism Inborn Errors Diet Therapy Embolism Paradoxical |
| Zdroj: | Pediatrics in Review. 34:280-284 |
| ISSN: | 1526-3347 0191-9601 |
| DOI: | 10.1542/pir.34-6-280 |
| Popis: | A 16-year-old African American boy presents to the emergency department with right facial numbness, right upper extremity weakness, and slurred speech for 2 days. The symptoms started suddenly and were preceded by right calf pain 1 day before. Two weeks earlier, he was treated for a gunshot wound in his right thigh with debridement and internal nail fixation for a femur fracture. He was then sent home 3 days later with an acetaminophen and oxycodone combination for pain. He admits to having a brief period of shortness of breath immediately after the symptoms started and denies any other symptoms. He also admits to being very sedentary since his last admission. He does not have sickle cell disease and denies any significant family history and any drug, alcohol, or tobacco use. His heart rate is 116 beats per minute, temperature is 98oF (36.7oC), respiratory rate is 18 breaths per minute, blood pressure is 116/73 mm Hg, body mass index is 19, and oxygen saturation is 99%. His physical examination reveals a right facial droop with an asymmetric smile and right eye blurriness (during examination the patient said that the objects were out of focus). His tongue deviates to the right on protrusion, and he has decreased right facial sensation to pain and temperature. Lungs are clear to auscultation, and cardiac examination findings are normal. His right hand also has decreased sensation and strength compared with his left. His right calf appears swollen, and on palpation he experiences significant tenderness. The range of motion in his right leg is also limited due to pain. Initial laboratory tests reveal a D-dimer of 4362 ng/mL and a erythrocyte sedimentation rate of 41 mm/h. Additional laboratory and imaging studies confirm his suspected diagnosis. A 25-day-old girl presents with 3 days of dark black stools. The … |
| Databáze: | OpenAIRE |
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