Monday, November 21, 2011

The Grecian Bend

Hi everyone. I hope you have a happy Thanksgiving week. There will be no case on Thursday because of the holiday, but this is a great case - will post the answer next Monday.

This posture, seen with female socialites in the late 19th century, looks similar to workers building the Brooklyn Bridge in 1883.

These days, you don't see much of that disease. But instead, you see something related to the liquid shown above. You're on a plane flying from San Diego to New York when you hear an overhead page, "Are there any doctors on board?" Reluctantly, you hit your call button.

A few minutes later, you are rushed to the aisle-side of a 30 year old gentleman. "I knew I shouldn't have gotten onto the flight," he says. "In the airport, I just had the sense that something was wrong, I was tired, everything hurt, I had no appetite, and I had a splitting headache. Now, my elbows and shoulders hurt, and my chest itches. My arms and legs feel weak and they're tingly too."

When you examine the patient, he has full range of motion of his joints, pain is not exacerbated with movement, and there is no erythema or swelling of his elbows or shoulders. He does have some erythema on his chest and some mottling with cyanosis. His neurologic exam is significant for some mild weakness of the extremities. His pulse is 80. He doesn't feel febrile. You try to take the blood pressure with the airplane's sphygmomanometer and stethoscope but can't hear a thing. His respiratory rate is 18.

Challenge: You forgot to take a social history on this patient. What are his hobbies?

First image is in the public domain. Second image is shown under Creative Commons Attribution Share-Alike License.

3 comments:

Anonymous said...

the bends--scuba diver

Anonymous said...

Scuba Diving.

Craig Chen said...

wow, good job!
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The Grecian Bend

The patient’s hobbies include scuba diving. This case describes decompression sickness, also known as the bends, or Caisson disease. Decompression sickness occurs when a diver descends and breaths air at increased pressures, loading the tissues with increased quantities of gas (oxygen and nitrogen, which is depicted in the photo). When he returns to sea level or goes above sea level, the gas tensions in the tissue exceed atmospheric pressure and form bubbles, causing the symptoms described.

Sources: UpToDate; Wikipedia.