🚀 go-pugleaf

On Fri, 31 Jan 1997 16:47:41 GMT, Krin135@AOL.com (Charles S. Krin, DO
FAAFP) wrote:


>You are called to the apartment of a 25 year old white female who has
>recently delivered a baby without problems. Pregnancy was normal, and
>both mother and child came home in three days. Mother has been breast
>feeding 10 minutes each side every 2 hours since discharge 2 weeks
>ago. You were called by the visiting nurse from the local Health
>Department who was checking on the new mother. The mother is somewhat
>distraught at the time of your arrival.
>
>Mother is complaining about right upper quadrant pain which has
>increased over the last week. She has also noted easy bruising. Her
>appetite is still down and mother has lost about 15 pounds since
>birth. She complains of puffiness in the face today.
>
>Vital signs: B/P 130/86 left, 128/78 right, pulse 100, temp 100.4,
>resp 20 and shallow- she states it hurts to breath.
>
>Primary and secondary assessment are completed, indicating mild facial
>swelling, Pupils are equal round and reactive to light. Eyes track
>well and together. Neck showes no nodes, masses, venous distension or
>nuchal signs.
>
>Lungs are clear with good air movement. Heart sounds are moderately
>hyper dynamic, but regular rate and rythem with a grade II/VI murmur
>heard best at the lower left sternal border.
>
>Abdomen is parous, soft, with reduced muscle tone. There is diffuse
>tenderness most impressively over the right upper quadrant and the
>supra pubic area. OB pad is in place, and shows a scant amount of
>bloody discharge.
>
>Extremities show no clubbing, cyanosis or edema. 
>
>Skin shows no jaundice, but multple small bruises are noted.
>
>Question 1: What other information do you want to get from the mother
>or the visiting nurse?

Has the baby been assessed and are there any similar symptoms?
Is there a partner?
Is the mother on any form of medication? e.g. Aspirin or other
anticoagulant.

>Question 2: How fast do you want to get this patient to the hospital?
Immediate admission.

>Question 3: What would your first treatment be?
Give oxygen via facemask, encourage controlled breathing.
Obtain venous access.

>Question 4: (for advanced credit...) What is your differential list of
>problems (diagnosis list) at this time.
? Diaphrammatic hernia.
? Thoracic aneurysm.
? Appendicitis possibly ruptured.
? Trauma/physical abuse.

>Hint: When you hear hoofbeats, look for horses, but occasionally
>zebras will show up.
>
>Please respond by email if you think you have the diagnosis list,
>otherwise feel free to post to the group.
>
>
>Charles S. Krin, DO FAAFP
>Krin135@AOL.com KC5EVN
>"Reckless, Hell! I hit jus' where I was aimin'"
>   "Bubba Shot the Jukebox!" Mark Chestnut, 1995
>

"Smoke me a kipper, I'll be back for breakfast." 
 Ace Rimmer. (RD)