Just looking for some thoughts on this call the other day.

[leoemt]

Actually, someone did bring that up:



I'm really intrigued by this scenario too, but unfortunately, I don't think we will ever know because we don't have access to any records other than the first-hand experience provided. Really, I think only an autopsy could be definitive.

Sorry my bad, I read Maine Iac's post but apparently I missed that. So much for my observation skills.

 

[shiroun]

IF I haven't posted this already, has anyone considered triple A? Stiff mass would fit, it could have been a posterior tear when he was lieing down, and when he positioned himself he could have severely torn it, causing that stiff mass to appear, and disappate when he laid down (it would receed a bit), but would still be present.

 

[Lfd128]

Sounds like a high abdominal aneurysm. Cyanosis onset due to restricted blood flow and mass of aneurysm could have been exasperated by a clot dislodged during the physical activity. Short of administering thrombolytics, there's not much that could be done.

 

[Aidey]

The description given in the OP and one of the follow up posts fits an abdominal hernia EXACTLY. This is a horses vs zebras one.

 

[Swimfinn]

i would have thought pneumothorax

 

[soon2Bmedic]

maine iac, i agree with the AAA!! i am still a medic student but, its the only thing that would make the superior cyanosis make any sense to me. if the guy had a AAA and he was sitting up any at all, then he would lose afterload and therefore lose perfusion to everything above the heart... right?

 

[soon2Bmedic]

Sounds like a high abdominal aneurysm. Cyanosis onset due to restricted blood flow and mass of aneurysm could have been exasperated by a clot dislodged during the physical activity. Short of administering thrombolytics, there's not much that could be done.

you really wouldn't want to give thrombolytics to someone your suspecting to have an internal bleed!! they will just make them bleed out faster.

 

[OzAmbo]

Cyanosis of the type described is associated with forms of obstructive shock, with the main culprits being pericardial tamponade and either saddle massive PE. The mechanism of this cyanosis is poorly understood. When i was doing my bachelors degree i tried to do a literature review on the mechanism of this particular cyanosis and came up with the "poorly understood" line, but my google fu is weak and im sure there is more out there then i was able to locate as an undergrad.

Someone threw coarction of the aorta out there, but i doubt this guy got this far into life without already showing symptoms of that previously.

Thoracic aneurysm fits if they are bleeding into their mediastinum / pericadial sac and the blood loss is limited

Massive PE / saddle PE has been know to cause this type of cyanosis, which im leaning towards as the patient does not appear to have a gas exchange problem (sats 94, RR30 with a clear chest) obvious tissue hypoxia but with good gas exchange (assuming he has normal blood volume and Hb levels) which tells me its more likely an 02 delivery issue. (i bet 5 dollars his ETC02 would show hypercapnia).

so im with obstructive shock - either saddle PE or pericardial tamponade

I think the transient rigid epigastric mass is a red herring ias it doesn't really fit the rest of the presentation, at least in my opinion

 

[karaya]

No capnometry?

 

[Doczilla]

Sounds like a high abdominal aneurysm. Cyanosis onset due to restricted blood flow and mass of aneurysm could have been exasperated by a clot dislodged during the physical activity. Short of administering thrombolytics, there's not much that could be done.

Huh?

 

[STXmedic]

Either a poor understanding of aneurysms, or of blood flow.... Or poor at putting thoughts into words... :unsure:
Had to read it several times, each making my head hurt worse...

 

[SDog]

No capnometry?

I too am curious about the capnometry. It could help rule out PE (or indicate). Some research shows that wave lengths that show "crude oscillatory ripples" indicate PE. Very cool stuff . To me capnography is exciting just because it's a diagnostic tool we get to use!