The case of the month
45 yo male presents via EMS after he “passed out 2 times” hitting his head.
You watch EMS rolling the patient into the room, the patient is awake speaking in full sentences but seems to be working a little to breathe. The patient states that he had outside side walking in the 110-degree heat to a grocery store. when he passed out 3 times, each time he would get up and try walking again; finally someone saw him and called an ambulance. He denies any preceding headache, chest pain, or shortness of breath. He is currently denying any hemoptysis, N/V, blurry or double vision, neck pain, abdominal pain, diarrhea, new rash or petechiae, recent travel outside of the states. He does not drink nor smoke.
On further questioning the patient denies any hx of PE, DVT. He does not take any medications and has never had anything like this before.
HEENT: large 3.5cm laceration to the scalp, hemostatic with compression bandage in place, TMs clear, no other signs of trauma, no septal hematoma, no malocclusion
Neck: supple, no pain with C spine midline.
Heart: tachycardic without murmur.
Lungs: clear bilateral
Abdomen: soft non-tender no distended.
Extremities: Abrasion over RUE with concussion and hematoma. No lower extremity edema, no palpable cords, negative homan sign.
Skin cap refil < 2 seconds
Neuro: AAOx4 moving all extremities, CN 2-12 grossly intact.
Eyes: PERRLA, EOMI.