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GI Case Studies NOTES 12. A 58-year-old man presents to the emergency room with acute onset of discomfort in his lower chest that occurred in a restaurant twenty minutes ago while he was eating a large steak. He denies any prior such symptoms. He now has difficulty swallowing his saliva and appears acutely uncomfortable. He has no prior history of chest pain. On physical examination, his blood pressure is l30l84, his heart rate is 88, and his respiratory rate is 18. Heart and lung exam are unremarkable and his abdomen is soft and nontender.
Hyperinflation of one lung on CXR - foreign body (the object is often radioluscent) Page 30 Kaplan Medical Pediatrics Case Studies E. NOTES Acute work-up 1. Vital signs (respiratory rate, heart rate, blood pressure, temperature) 2. Physical exam - focal, diffuse 3. Oxygen saturation (pulse oximetry blood gas) 4. CXR 5. Blood cultures F. Tests to order 1. lf you suspect asthma severe, trialof meds 2. lf you suspect pneumonia severe, CXR, cultures 3. 4. - place infant prone lf you suspect structural abnormality - bronchoscopy, - oxygen saturation, blood gas if - oxygen saturation, blood gas if ll you suspect laryngomalacia barium swallow 5.
4"F, appears slightly dehydrated, and has no abdominal tenderness. Rectal exam reveals trace guaiac positive stool. 30. A 29-year-old chef complains of four days of abdominal pain and low grade temperature. He has also developed non-bloody watery diarrhea. 4'F and there is right lower quadrant tenderness. He is guaiac negative on rectal examination. 31. A 34-year-old HIV positive homosexual man describes two weeks of increasing diarrhea that has turned bloody. He denies any recent anal intercourse or sexually transmitted diseases within the last nine months.