Tuesday, January 04, 2011

All That Wheezes is Not Asthma (sorta kinda)

Alright gang. Handed off from day shift... 17 year old, asthmatic, wheezing upon presentation, pounded with steroids and nebs, no longer wheezing... Pulse 135, chest feels heavy. Fire away.


  1. Pneumomediastinum?

  2. pneumomediastinum! I've only seen one - kid had eaten pizza very fast, and the crust caused him to "choke". Whoops

  3. The sad thing is he's Georgia's top Recruit...
    and if you think I'm gonna let you forget the loss to UCF...lets just say, the Pyramids will wear down first...but I'll play Med Student...

    The Black thingies should be bigger...
    and the White thingies should be..umm they look OK.
    and whats with the "Gang" bit? are you turning into Larry King?

    "WATS THE QUESTION!!!!!????"

    and that Rotator Cuff looks a little sketchy..



  5. There is an arrow wedged under the skin

  6. I think the left chest finding is either a necklace or (more likely) and ECG lead. The anterior mediastinum looks abnormal so I'm thinking one of the 4 Ts (thyroid tumor, thymoma, teratoma, or terrible lymphoma). I'll take lymphoma for $400, Alex

  7. Is the metal due to an EKG sticky?

  8. That's a high cut through the base of the neck. Trachea is not compressed but there's air in the soft tissues. Spontaneous pneumomediastinum/pneumothorax. It happens in asthma. I've seen it in scuba divers, with high pressure ventilation, and once after a rigid bronch.

  9. Last spontaneous pneumothorax I saw was a dude I tried to put a subclavian line in during residency...
    The Sissy Fagboy Panty Waste Internal Medicine Resident(Sorry, thats my Navy Training talking)couldnt get a line so he paged the SICU Resident, ME.
    I Got the line fine, along with a bit of the Right Upper Lobe..
    So I paged the SICU Resident, ME to come put in a Chest Tube..
    I actually used to do that, Page Myself, its like Playing with Yourself, except theres no refractory period, or scrubs with crusty stains, we still had these 1980's voice pagers that were great for playing jokes, see, you'd page someone you didnt like during Grand Rounds, and say something really obnoxious and dirty and everyone would give the Victim dirty looks,even though he/she was the object of the prank, wasn't fair really...


  10. New-mo-media-stein-um.
    the metal thing is an external pacer.

  11. There's more isn't there 911.

    Hey, you never told us who won the last game. Not the Sinville psych game, but the abnormal abdomen game.


  12. dear SCRN and crew,

    you are all good... except you frank.... but that was the damndest closest thing to a real radiology read i have heard since... uh... since the last time i talked to one of those night radiologists located in cyberland.

    PNEUMOMEDIASTINUM. no big deal for the patient, but she just wouldn't break from her asthma attack... d dimer proved lab was open and as undecided at frank's read of the film... chest CT followed... pt did well.

    and frank, challenge you to go a week without talking about your penis or how bad the bulldogs suck. you know, i like you well enough that i won't hit you too hard if the ducks beat you guys... by that i mean your team... i mean Auburn... because last time i checked, you weren't even on the sidelines.

    peace, out.

  13. 9-11..or should that be 6-7?? :)
    and thats a "Smiley Face" I'm laughing with you, cause we know real Southern Men don't cry...
    and I could have said the CT was UGA's Pretty Boy White Bread QB after Mean Nick Fairley gave him the Mandible Claw,but I didnt...
    and I could have said Mark Richt has the Coaching Ability of Trig Palin but I didnt...
    and I could have said UGA VII or VIII showed more team spirit than that bunch of Prima Donna 5 Star Thug Lifes UGA recruits every year, Auburn recruits GENTLEMEN Student Athletes, like Lee "Chop Block" Ziemba...

    SEC lose in a National Title Game? I guess it COULD happen, if a Muslim Black Supremicist can be President, anythings possible...
    The Sun could Explode, Barney Frank could marry Jessica Simpson, Joe Biden might say something thats not totally moronic.
    But the SEC lose to a Dope Smoking-Hoodie Wearing-Latte-Sippin-PAC-10-Team? Not in my lifetime.
    Cause if the Tigers havent sewn it up by the 4th Quarter, I've got some "special" pills I'm gonna take.
    No Cyanide, just some perfectly legal Xanax's, in fact I might need a Xanax patch for all the Shite I'm gonna get get thrown back at me...
    and don't wanta go all Ronald Reagan on ya, but.....
    OK, I havent actually paid to go to an Auburn Game since 1993, and that was only because they were on probation and couldnt play on TV, but a fraction of a cent or so of that Money Cam Newtons Dad (Allegedly) got was from your's truly..
    So don't be H8-in, if a black hole ever sucks the Earth into a Bizarro Universe where UGA could play in a BCS Title Game, I'd chear for the Dogs...
    Cause in the Bizarro-Universe everythings reversed...

    Frank "14-0" Drackman

  14. On this, a football evening, I send this out to the Old Fart Horned Frog:

    Jason from Coeur D' Alene, ID
    What are your thoughts on Andy Dalton from TCU?

    Vic: I think he might have a brand on his hip: “Property of Gene Smith.”


    Frank, good luck, but it really wouldn't bother me if the mass-bird-die-off, tonight, was War Eagles, while the Ducks paddle along. I doubt it, though and good luck to my fellow SEC fan.

  15. J, thanx! That is a site only a truly troubled person could have found much less read all the way down to the comment about the next Tom Brady/Aaron Rogers/Drew Brees of the NFL..
    Dalton will be a perfect NFL prospect. He's 6'3", 240lb, runs a 4.6..Oh and he won more NCAA games at quarterback that anybody but that kid McCoy. And he's a truly devout Christian that doesn't wear it on his sleeve(not like the tebow-nater)..He studies hard, works harder than anyone else on the team, is leader vocally and by example. You'd want him to marry your daughter..I wish he'd marry mine!!
    I think he might be a late 1st round pick(Jags?) More likely 2nd or 3rd. I really expect him to be a great not just good NFL QB..
    Remember, you heard it first here!!

  16. Old Fart,
    Just to show I'm a Good Winner,

    WAR MOTHER EFFIN DAM EAGLE!!!!!!!!!!!!!!!
    Goodluck Steppin up to the Big Least, I mean East, guess Seton Hall will have some competition now...
    And I could say the closest TCU will get to a BCS Championship is driving past Auburn on the way to that big USF game(ooohhhh...Ahhhhhhhhh...)

    But congrats on beating Northwestern, or Akron, or whoever you played in that bowl game nobody watched.
    And why Texas "Christian" University? is there a Texas "Muslim" University? a Texas "Buddhist" University, a Texas "Jewish" University? and shouldn't your mascot be something other than a Horny Frog??
    And there's no shame in finishing second, just ask AlGore.

    Frank "S-E-C!-S-E-C!) Drackman

  17. Oh now Frankie, don't strain those 2 spirochetes holding hands in your cranium, but see if you can follow this...
    In 2 months, Cammie is indicted along with daddy on Federal money laundering, postal fraud, take your pick and the war eagle eats crow and, of course, loses the nat'l championship, the Heisman and it's wins are vacated...

    That leaves only 1 undefeated 13-0 team..The unbeaten, un-indicted TCU Horned Frawgs!!!
    Your true National Champions!
    I cain't wait!!!
    And The Great Republic of Texas does have a Joo U, it's called UT..

  18. Frawgs?

    Is that supposed to be like whassup dawg? or who let the Frawgs out ...nevermind.

    Awww, poor (but cute) OF.


  19. Really Old Fart, your gonna play the Neurosyphillis Card???
    and I thought we had a deal, you don't talk about the spirochetes in my brain, I won't talk about the Spirochetes in your mouth:)
    and sure, maybe Auburn will get put on probation, like TCU in the 1980's which must seem like last week for someone as ancient as you...Yeah, it was 1986, or 5 Conferences ago, depending on weather you count the Big (L)east or not.
    Seriously, Lindsay Lohan, wait a minute, let me use someone you'll know, LIZ TAYLOR hasn't slept around as much as you guys, lets see, Southwest Conference, WAC, Conference USA, MWC, and now the Bermuda Triangle that is Big (L)east Football.
    Oh and congrats on beating 3 ranked teams(Oregon State, Utah, Wisconsin) not quite up there with Clemson, Mississippi State, Alabama, LSU, Arkansas, South Carolina(Twice),Georgia and those Potheads with the psychedelid tie died unis...
    Oregon, Neurofibilary Tangle Breath.
    But y'all are steppin it up a notch next season, lets see, Baylor, UNLV, Air Force, San Diego State, Wyoming, SMU, and oh yeah COLORADO STATE,
    OK, you are playing Boise State, Ooooohhhhh
    Maybe you could play Nevada for one of the 2 open dates you haven't filled yet.
    You remember, Nevada, who beat Boise State, who beat you like Ike beat Tina...
    and I know it sucks to go 36-3 over the last 3 years and only the Big (L)east asks you to dance...
    But hey, not everyone forgets who finished second...
    lets see, there's AlGore..



  20. Oh Frankie Pooh, I didn't want to upset your Tay Sachs challenged mind so. At least you were smart enuff not to argue you bought the kid...from his daddy. I thought you guys were thru with that slavery thing there Pablubama?!

    We can only play the people who are not scared of us, you know that. Nobody wants to play us, even when we give them home field every time. I'm getting used to beating OU in OK, why won't y'all schedule us? Too scared of what happened to Clemson last year? In Death Valley!
    Yep, we were put on probation because our coach at the time, the late Jim Wacker, found out that money was being paid to several super Frog players and immediately turned the program in to the NCAA, as any honorable coach would do. Never mind that no one had ever done that before. There is rarely honor in the coaching ranks. Coach Wacker was an honorable man and couldn't allow it to continue..GP would do it too.

    I'll stop now as I know all this reading is making your ganglia get all "swole up" Go count your chromosomes if you can still see 'em..

    And what's up with the birdy thingy? Your mascot is a pussycat!!

  21. Old Fart, I'd explain the War Eagle/Tiger thing but you'd probably have an aneurysm or something. Its really not that difficult of a concept, like how the Yankees are called the Yankees, AND the Bronx Bombers, and if your having the worst headache of your geriatic life, don't blame me.
    So I guess Texas is scared of TCU?, since there only 61-20-1 against you, but oh yeah, you did beat em in 1992, and 1967, way to keep it close.
    But hey, your 3-30 since November 22d, 1963, and why did JFK fly from Fort Worth to Dallas??? Probably so he wouldn't have to smell the stench comin from your laughably small even by Alabama High School Standards "Stadium", that y'all struggle to fill to its 44,008 capacity.
    OK, since you weren't ranked from 1959-2000, thats 42 years BTW, and y'all sucked so bad, you couldn't even win when you cheated!
    And go ahead and put down Alabama, you Neil-Young-Listenin-Probably-Don't-own-a-single-Skinnerd-8-Track-Your the one who might as well be living in Mexico.
    But hey, you do have that National Title, what was it? 1938? Which you probably remember like it was yesterday, cause your demented..
    Had enough?
    Too Bad, Suckah,


    PS How'd you know about the Tay Sacks?