Hey guys, and welcome back to Diagnose This; the game for all of you aspiring medicos and medicine fanatics alike to learn and test your skills.
Last week we had the case of the young man with chest pain and some worrying test results. The preliminary diagnosis that we were looking for was myopericarditis: inflammation of the myocardium and pericardium. The reason for this was the raised hs-cTn levels, an indication of damage to the myocardium, paired with the ST-elevation in all ECG leads and the relieving of pain on leaning forward. The other investigations that would need to be performed are an echocardiogram to check for both heart function AND the presence of exudate in the pericardium (a.k.a pericardial effusion, and cardiac magnetic resonance (CMR) imaging. Finally, the management all depends on the severity; colchicine has been known to reduce the recurrence of MPC and, when paired with NSAIDs, can help with the pain. If there is evidence of pericardial effusion then more drastic measures need to be undertaken: pericardiocentesis will need to be undertaken with presence of cardiac tamponade/severe effusion, otherwise a conservative management should be undertaken with monitoring of the patient’s condition.
So fingers crossed you went well guys! This particular case may seem familiar to some of you; that would be because this is what happened to me! So yeah, hopefully you guys got the diagnosis, otherwise you could’ve killed me… ha…ha…
Anyways, onto the next case!
You are called to a post-op patient in the ICU whose BP has fallen to 75/40. They have tachypnoea and are febrile (38.4C), with a largely decreased urine output and a GCS of 5 (M2 V2 E1). You come to the quick conclusion that the patient is in shock.
What is the acronym used for an immediate trauma review? What type of shock is found in this patient? What would be the treatment for this patient (be specific: dosages and volumes please guys)?
Tune in next week and find out!
The first ever ICU was founded in 1953 by Bjørn Aage Ibsen at the Kommunehospitalet in response to the polio epidemic of the time!
By U.S. Navy photo by Photographer’s Mate 1st Class Shane T. McCoy. – This Image was released by the United States Navy with the ID 030423-N-6967M-090