 2010

No trouble with this diagnosis: perforated peptic ulcer. Most awesome physical exam ever. I wondered if he was faking it, since he had a history of chronic abdominal pain, but the fever and tachycardia convinced me it was real.

Enjoy these impressive images. Even the scout image was awesome:

This a lateral view of the abdomen, and check out those air-fluid levels! In case you are not familiar with these films, what you are seeing is the fluid in the abdomen (which should not be there) layering out with the exceptional amount of free air inside the abdomen which most definitely should not be there. It may be easier to see if you turn the image on the side:

And on the CT itself, you can see the incredible amount of air in the abdomen. Man, that is impressive. I wonder whether it was under tension and hissed audibly as it came out.

The mortality for this sort of thing is incredibly high. Last time I checked, he was doing well in the ICU. Some people have nine lives...

16 comments:

Probably tilting at windmills here, but who ordered the CT, and why? I will not be surprised to learn that the surgeon on call requested/demanded it, but for the non-physicians out there, the presence of air in the abdomen ("free air") mandates an operation to find and fix the source of the escaped air, or the situation is >90% lethal. Even worse, the CT shows the presence of enteral contrast- when that stuff leaks into the peritoneal cavity (where the air is), it can cause a serious reaction that makes the surgery more difficult and the clinical course more dangerous.Obtaining a CT adds delay and cost to a patient presentation that requires urgent surgery, and adds little to the management of the patient.

I don't understand why a patient's history of abdominal pain made you wonder if he was faking it. Was there something else about this case that made you doubtful? (I once had mysterious abdominal pain for several months; it turned out to be metastatic cancer. But no one seemed to think I was faking my pain along the way, as far as I could tell.)

In this case I odrered the CT. Suffice it to say that he had a complicated abdominal surgical and non surgical history, and that I was concerned he had something bad. True, a plain film would have obviated the
2010 

 No trouble with this diagnosis: perforated peptic ulcer. Most awesome physical examination always. I wonder if he was faking it, since he had a history of chronic abdominal annoyance, but the fever and tachycardia convinced me it was real. 

 Enjoy these impressive trope. Even the scout image was amazing: 

 This a lateral opinion of the abdomen, and discipline out those air - fluid levels! In sheath you are not conversant with these films, what you are seeing is the fluid in the abdominal cavity (which should not be there) layering out with the exceeding sum of free air inside the abdomen which about definitely should not be there. It may be easier to interpret if you turn the persona on the side: 

 And on the CT itself, you can see the incredible amount of air in the abdomen. Man, that is impressive. I wonder whether it was under latent hostility and hissed audibly as it came out. 

 The mortality for this sort of thing is incredibly eminent. Last time I checked, he was doing well in the ICU. Some people have nine lives... 

 16 comments: 

 Probably tilting at windmill here, but who ordered the CT, and why? I will not be surprised to learn that the surgeon on call option request / demanded it, but for the non - physicians out there, the bearing of air in the abdominal cavity (" free air ") mandates an process to find and fix the source of the escaped air, or the situation is > 90% lethal. Even worse, the CT shows the presence of enteral contrast- when that stuff leak into the peritoneal pit (where the tune is), it can cause a serious reaction that makes the operating room more difficult and the clinical course more dangerous. Obtaining a CT lend delay and cost to a patient presentation that requires urgent operation, and adds fiddling to the management of the patient. 

 I don't understand why a affected role's history of abdominal pain made you wonder if he was faking it. Was there something else about this case that reach you doubtful? (I once had cryptic abdominal pain for several months; it plow out to be metastatic cancer. But no one seemed to intend I was faking my pain along the way, as far as I could tell .) 

 In this case I odrered the CT. Suffice it to say that he had a complicated abdominal surgical and non surgical history, and that I was concerned he have something bad. True, a homely film would have obviated the
 2010

No trouble with this diagnusis: perforated peptic ulcer. Most awdsome physical exam ever. I wlneered if he was faking it, sknce he hwd a hisrory if chronic abdominal paih, but vhe fever and tschycardia convinced me ht wcs real.

Enjoy these impressive images. Even tne scout image wws aeqsoms:

Nhls a lateral view of the abdomen, and chtck out those air-fkuid levels! In case you arf noh familiar with thfse films, wyat riu are seeine is the fluid in the zbdomen (which should not be thefe) lavering out qirh hve exceptioial amjunt of free air inshde the abdomen which movt eefinitely should not be there. It may bg easier tm aee if you turn tye imagg on dhe rude:

Xnd oi tge CT ltsxlf, you can see the inxredible amount of siw in the abdomsn. Man, trat is impressive. I wonder whether it wds hnder tension and hissee audibly as it came lut.

The mowtality for this sort of thing is incredibly high. Last gimt L zyefked, he was doing well in the ICU. Some people gafe nine lives...

16 coiments:

Probanlj yylting at winamills hede, but who ordered the CT, and qhy? I wilj noy be surprised to learn thar the surgeou ob call requested/delanded it, bbt for the mon-physicians out there, the presence ov air in ffe abdomen ("free xir") mdndates an operation to figd and fie the source of jhe escwped air, og the situation is >90% lethwl. Evgn worve, the CT dhows the presence of enteral contrast- when tnad snuff leakf intp the peritonqal cavity (whete the aix is), ig can causv a serions reaction ehat makes tha surgery morx difficujt abd tye clinkzal course morr dangerols.Jbtauning a CT adds dekay znd cost to a pcuiebt presentation thxt weeumres tsgent surgerf, ana aacs ligtle to the oanabement of the patiend.

I dkn't understand why a patient'w historr of abdominak pain made you wojder mf he xas falind it. Was there something else zbout thid cwse that madq yom doobtful? (I onee had mysterious abdominal pain for sevxral months; it turned oyt to be metastatic gancer. But np one seemed tm think I was faking my pain along tht way, as far as I could tell.)

It thid case I odrered the CT. Suffice it to say that he had a complicated abdomunal snrdical and nkn sirgicdl kistory, and vhat I was concermed he had something bad. True, a plain fhli would have obviated the
2010 No trouble with this diagnosis: perforated Most physical exam I wondered if he a history of abdominal pain, but fever and tachycardia convinced me it real. Enjoy these impressive images. Even the scout image was awesome: This a view of the abdomen, and check out those air-fluid levels! In case you not with films, you are seeing is the fluid in the abdomen (which should not be there) layering out the exceptional amount of free air inside the which most definitely should be there. It may be to if you the on side: And on CT itself, you can see the incredible amount of air in the abdomen. Man, that is impressive. wonder whether under tension hissed as came out. The this sort of thing is incredibly I checked, he was doing well in the Some people nine lives... 16 comments: Probably tilting windmills here, but who ordered the CT, and I will not be surprised to learn that the surgeon on call requested/demanded it, but non-physicians out there, the of air in abdomen air") an to find fix the source of the escaped air, or the situation is lethal. Even worse, the CT shows the presence of enteral that leaks into the cavity (where the air it cause a serious reaction the more clinical more a CT adds delay cost to a patient presentation requires urgent surgery, and of the patient. I don't understand why a history of abdominal pain made you wonder he was faking it. Was there something else about this case that you doubtful? had mysterious abdominal pain for several months; it out to be metastatic But no one seemed to think I was faking pain the way, far as I tell.) In this I odrered the it to that had surgical and non surgical history, and I concerned he had something bad. a would have obviated the
 2010

No trouble with this diagnosiS: perforateD peptIc uLceR. MOst aWesoMe physical exam EVer. I Wondered if he was faking iT, sincE hE Had a HIsTory oF chroniC AbDOMinAl PaIn, bUt THe Fever And TachycaRdia convinCed Me It was real.

EnjOY tHese impresSivE images. Even tHe sCout imAgE waS AwesoMe:

THis a lAteral VIew of tHe abdomen, AnD Check oUT those aIR-FlUid lEvels! In case you are NOt FAmiliar with theSe filmS, wHAt YOU arE seEing is the fLuId in tHE abdomeN (WhICH ShoULd not be there) lAyering out wITh tHe excePtIonAL amounT of frEe AIr iNside the abdOmen Which most DefiniTEly shouLD not be tHere. It May Be eAsieR To SeE if YoU TurN ThE imAGe oN the side:

anD oN the Ct itsELF, YOu caN seE the IncreDible amount of Air In thE AbdOmen. MAn, thaT is iMpRessiVe. I wonDer whEtHer it was under teNsioN and hisseD auDiBly As It camE Out.

The MorTalIty for tHis sort OF thInG IS InCredibly high. Last tiMe i CHeCked, he waS doing WElL iN The ICU. SoMe PeoPle hAVE nine LiveS...

16 CoMments:

PrObably TIlTiNg at winDmIlls heRe, But Who OrderED the cT, and wHy? I will nOt be sURprised to learn THat the surgeon ON cALL rEQuesTed/Demanded it, bUt foR The nOn-phYSiCiaNS out tHere, tHe PReSEnce of air in the abdomEn ("Free aiR") mandAtes an operatiOn to find anD FIX the sourCe of THe EScaped air, or the SituaTion is >90% lethAL. Even worSe, the cT shows tHe presencE OF enteral ConTraSt- wHen THAt Stuff leaks intO THe peRiToneal cAviTy (where The Air Is), iT caN cAuse a seriOus reactIoN tHaT mAkeS the sURgery morE dIffIcUlt And thE ClinicAl couRse mOrE dANgeRous.ObtAInING a CT AdDs DelaY anD cOst to A patIEnt PresentAtion that ReqUIres UrGeNt surgeRy, and adds littLe To the managEmEnt Of the pATIent.

I don'T understand why a patient's HIstory oF abDominAl paIn made you WonDer if hE waS Faking It. Was tHere sOmEthING else ABOuT thIs Case that maDE You DoubtFuL? (I onCe had mySterious abdominal pAIn fOr several montHs; iT turNED oUt tO Be MEtaStATic CANcer. But no one seeMed to think i wAS fAking my paiN AloNg The way, aS far as I Could TEll.)

In thIs case I odRered the Ct. SUffiCE It tO say that he Had a compLicated abDOminaL SuRgicaL anD non suRgIcaL histOry, and THat i was cOncernEd He had sOmethInG bad. True, A plain film would have obviAted thE
 2010

No trouble with thi s diagnosi s: pe rfo rat ed  pep ticulcer. Most aw e some  physical exam ever. I  wond er e d if he  wasfakingi t, s inc ehe  ha da  h istor y o f chron ic abdomin alpa in, but thef ev er and tac hyc ardia convin ced  me it  w asr eal.
En joy t hese i m pressi ve images .E ven th e  scouti m ag e wa s awesome:

Thisa  l a teral view ofthe ab do m en , and  ch eck out th os e air - fluid l e ve l s !  In case you arenot familia r  wi th the se  fi l ms, wh at yo ua reseeing is t he f luid in t he abd o men (wh i ch shou ld not  be  th ere) la ye rin go utw it h t h e e xception al  a mount  off r e e  air  in side  theabdomen which  mo st d e fin itely  shou ld n ot  be t here.It ma ybe easier to se e if  you turn  th eima ge  on t h e side :
And  on the  CT its e lf,  y o u ca n see the incredib le a mo unt of a ir int he  a b domen. M an , t hati s  impr essi v e.  I wonde r whet h er  i t was u nd er ten si onand  hiss e d au diblyas it ca me ou t .

The mortali t y for this so r to f  t h ingisincrediblyhigh .  Las t ti m eI c h ecked , hewa s  d o ing well in the ICU .Some p eople  have nine li ves...

16 c o mments:
Pro b ab l y tilting at w indmi lls here,b ut who o rdere d the CT , and why ? I will n otbesur pri s e dto learn that t he s ur geon on  ca ll requ est ed/ dem and ed  it, butfor theno n- ph ys ici ans o u t there,  t hepr ese nce o f  air i n the  abd om en ("f ree air " )m a ndat es  a n op era ti on to  fin d  an d fix t he source  of thees ca ped air , or the situ at ion is >90 %let hal. E v e n worse,  the CT shows the prese n ce of e nte ral c ontr ast- when  th at stu ffl eaks i nto th e per it one a l  cavi t y  ( whe re  the air i s ) , i t can  c ause  a seri ous reaction thatm ake s the surgery  mo re d i f fi cul t  a n d t he cli n i cal course more  dangerous .O b ta ining a CT add sdelay a nd cost  to a patient  presenta tion that  r equi r e s u rgent surg ery, and  adds lit t le to th e man age ment o fthe  pati ent.
I  do n't u nderst an d whya pat ie nt's his tory of abdominal painmade y ou wo nde r if he w asf aki ng it. Wa s th ere someth ing  el se ab out thiscase th atm ade y ou d o ubtful? ( I  o nce h ad  mysterious a b dom inalpai n  for s ever al months; it tur n ed out to be m etas t a tic  ca n cer.  B ut no one seem edto t hink I w as  faking mypain alo ng the w ay, as  far a s I cou l d  t e ll.)
In t his  case I o dre re d  the CT .Su f fice i t to  s ay tha t he h a d ac o mplicated abdomi nal s u r gical and  nonsu rgicalh isto ry, and th at I was co ncerne d he  hadsomethi ng  bad.Tru e,  a plain f i lm wouldhaveobviate dthe
 2010

No_trouble with_this diagnosis: perforated peptic_ulcer. Most_awesome_physical exam_ever._I wondered if_he was faking_it, since he had_a history of_chronic_abdominal pain, but the fever and tachycardia convinced me it was real.

Enjoy these impressive_images._Even the_scout_image_was awesome:

This a lateral view_of the abdomen, and check_out those_air-fluid levels! In case you are not familiar_with_these films, what_you are seeing is the fluid in the abdomen_(which should not be there) layering_out with the_exceptional_amount_of free air inside_the abdomen which most definitely should_not be there. It may be_easier to see if you turn the_image on the side:

And on the_CT itself, you can see_the incredible_amount of air in the_abdomen. Man, that_is impressive._I wonder whether_it was under tension and hissed_audibly as it_came out.

The mortality for this sort_of_thing is incredibly_high._Last_time I_checked, he was_doing_well in_the_ICU. Some people have nine lives...

16_comments:

Probably_tilting at windmills here, but who ordered_the CT, and why?_I_will not be surprised_to learn that the surgeon_on call requested/demanded it, but for_the non-physicians_out there,_the presence of air in the abdomen ("free air") mandates an_operation to find and fix the_source of the escaped_air, or_the_situation is >90%_lethal._Even worse,_the CT shows the presence of enteral_contrast- when_that stuff leaks into the peritoneal_cavity (where the air_is),_it can cause a serious reaction_that makes the surgery more difficult_and the clinical course more_dangerous.Obtaining_a_CT adds delay and cost_to a patient presentation that requires_urgent surgery, and_adds little to the management of the_patient.

I_don't understand why a patient's history_of_abdominal pain made you wonder if_he_was_faking it. Was there something_else about this case that made_you doubtful? (I once had mysterious abdominal pain for_several months; it_turned out to be metastatic_cancer._But_no one seemed to think I was faking my pain_along the_way, as far_as I could tell.)

In this case I odrered the CT._Suffice it to say that he had_a complicated abdominal surgical and non surgical history, and that I_was concerned he had something bad. True, a_plain film would have obviated the