28 year old presented to me in the FP clinic (Yuk, I know) today with back pain X 3 days. He has had it before, given muscle relaxers, and went away in 3-4 days and just wanted to get them again, however this is not the typical LBP, but in the thoracic region. Started when he was walking to his truck. I asked him the typical--fever, cough, sick contacts, SOB--he stated "actually i get a little SOB when I bend over, but know big deal." BP, pulse normal. NO breath sounds Left upper lung fields, and only minimal in left base. No tracheal deviation. Send him to ED--40-50% pneumo--no other problems except mild persistent asthma, no smoking, drugs, marfans, and he was a regularly looking guy. Ever since I saw my first spontaneous pneumo with Quinn in the ED, I have been waiting for another--never thought is would be in the FP clinic though!!!
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back pain?!?!
Started by jonwilli
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It seems to be a bizzare disease with bizzare presentations.
The only one I have seen personally was truly strange. Our boy, a smoker and known to have reactive airway disease, is sitting at home on a friday night when a car wreck happens in front of his house. He does not notice anything out of the ordinary until one of the victims from said wreck pounds on his door to have someone call for help. Patient answers, the excitement of the wreck causes him to have a panic attack, which leads him to have an "asthma attack". They call the medics who bring the wreck victims and the neighbor to our ER.
I got some strange looks when I presented this to my attending.
Anyway, after a couple rounds of neb tx, he is not improving, breath sounds becoming unequal... CXR... you know the rest.
Weird people.
The only one I have seen personally was truly strange. Our boy, a smoker and known to have reactive airway disease, is sitting at home on a friday night when a car wreck happens in front of his house. He does not notice anything out of the ordinary until one of the victims from said wreck pounds on his door to have someone call for help. Patient answers, the excitement of the wreck causes him to have a panic attack, which leads him to have an "asthma attack". They call the medics who bring the wreck victims and the neighbor to our ER.
I got some strange looks when I presented this to my attending.
Anyway, after a couple rounds of neb tx, he is not improving, breath sounds becoming unequal... CXR... you know the rest.
Weird people.
I had a spontaneous pneumo when I was 18. (No I don't have Marfan's). Not a pleasant experience. I was leaving my job at a research lab when I got a slight pain in my left shoulder. Felt like a muscle-ache so I ignored it. 10 minutes later, while I'm in the car driving home, 8 out of 10 pleuritic L chest pain. Could hardly breathe it hurt so much. Easily the worst pain of my life.
Definitely not something I recommend for anyone.
Definitely not something I recommend for anyone.
jonwilli said:
If you want to see another pneumo, aim down when you are doing yoru subclavians. When you get made fun of by your fellow interns, just tell them that it was a "spontaneous" decision.
And shouldn't you be done with medical school? Yuck, to end on a FP month.
Q
One of the PA's during residency had many spontaneous PTX's, which happened to occur during her periods....Apparently she had some endometrial tissue in her thorax that caused these PTX's. Strange stuff....
spyderdoc said:
Talk about a bad case of PMS! She must have been bitchy as hell with all that pain.
