Day-to-day medicine for medical students, interns and enthusiastic doctors!

An elderly male patient was transferred to medical casualty ward in the evening with a history of severe left sided chest pain for last 2 hours. It was revealed that in fact the patient got the pain only after he had fallen at home and the chest impacted on nearby chair. The pain was of pleuritic nature. On examination the patient was hemodynamically stable and the saturation was 100%. House officer noted some crepitus over the painful area. Air entry was symmetrical. He prescribed analgesics and ordered a Chest Xray. Several hours later the house officer was called to see the patient by the nursing officer as the patient was complaining of increasing shortness of breath. The patient was very restless and was dyspnoeac. Oxygen saturation was 89%. House officer noted his chest to be swollen and the crepitus was extending up to neck. His Xray which was taken few hours before was on the bed side table. The registrar was summoned immediately and with the help of the surgical team a...

A 60 years old male patient admitted with shortness of breath following trauma. He was found to have L/S pneumothorax to which an intercostal tube was inserted. He got symptomatically better. Next day evening strange commotion in the ward drew attention of the house officer. He rushed to see what's going on and got terrified to see the patient had detached the IC tube from the bottle. He was shouting and asking to be discharged. With the help of some attendants the house officer managed to calm down the patient and reattached the IC tube. Patient remained quite for few hours and during the night he again became agitated and was running around the ward shouting. Finally the house officer had to give a sedative and restrain the patient. Any thoughts?? Alcohol withdrawal! Lesson ~ Any patient, particularly a male, behaving odd after admission could be having acute alcohol withdrawal. ~ Before shouting at a patient who's acting weird in the ward pause for a moment and t...

An 80 years old lady presented to ETU with a history of severe right leg pain for 2 hours with sweating. She was very ill on admission with profuse sweating and tachycardia. ETU doctor attached her to a multimonitor. Her heart rate was 120/min and it was irregular. Blood pressure was 160/100mmHg. Diagnosis of Atrial fibrillation was made. As it could be a myocardial infarction she was referred to the cardiologist. They suggested to start her on Aspirin, Clopidogrel, Atorvastatin and Enoxaparin. A blood sample was sent for Troponin I titre. Two hours later, she was admitted to the medical unit. House officer was concerned as the patient kept on complaining about the leg pain. He touched the limb to find it dead cold! There was no pulse. Saturation was undetectable! Urgent arterial doppler showed complete obstruction of deep femoral artery. She was immediately sent for vascular intervention to save the ischemic limb. Lesson ~ You can come to various diagnoses merely by ex...