100 Cases in Clinical Pathology and Laboratory Medicine

A 77-year-old man calls 999 with backache, hypertension, and tachycardia. Paramedics arrive and provide initial assessment, including intravenous fluids. 100 Cases in Clinical Pathology and Laboratory Medicine offers 100 clinical scenarios to help medical students and junior doctors diagnose and manage patients.

Format: Paperback / softback
Length: 338 pages
Publication date: 09 February 2023
Publisher: Taylor & Francis Ltd

A 77-year-old man calls for help when he is experiencing severe backache. The paramedics arrive promptly to find him in excruciating pain, shivering from the cold, and feeling clammy. While at his house, they observe that he indulges in smoking and also reveal a history of hypertension. Upon arrival at the hospital, he is tachycardic and hypotensive, and intravenous fluids are administered to stabilize his condition.

You have been assigned the initial assessment of this patient. Let us delve into the details of his medical history, examination findings, and initial investigations.

The patient, a 77-year-old man, presents with a chief complaint of severe backache. He has a history of hypertension, which is a risk factor for cardiovascular disease. During the examination, the paramedics note that he is in severe pain, shivering from the cold, and has clammy skin. His vital signs include a heart rate of 120 beats per minute (bpm), a blood pressure of 100/60 mmHg, and a respiratory rate of 20 breaths per minute.

Upon further assessment, the paramedics notice that the patient has tenderness in his back and limited range of motion. He has no signs of trauma or neurological deficits. His chest examination reveals normal breathing sounds, and his heart sounds are regular without any murmurs. His abdomen is soft, non-tender, and normoactive.

The paramedics also elicit a history of recent medication use from the patient. He mentions taking ibuprofen for his backache, but he does not have any other chronic medical conditions or allergies.

Based on the patient's history, examination findings, and initial investigations, a diagnosis of acute lumbar spine pain is made. This diagnosis is supported by the presence of severe backache, limited range of motion, tenderness in the back, and the absence of neurological deficits. The tachycardia and hypotension observed on arrival may be related to the pain and anxiety associated with the condition.

The paramedics initiate treatment by administering intravenous fluids to maintain hydration and improve blood circulation. They also provide pain relief medication, such as ibuprofen, to alleviate the patient's pain.

The patient is transported to the hospital for further evaluation and treatment. In the hospital, a comprehensive medical history is taken, including details about the patient's past medical conditions, medication history, and family history. A physical examination is performed, including a thorough assessment of the cardiovascular system, respiratory system, and neurological system.

Further diagnostic tests, such as blood tests, imaging studies (such as X-rays or CT scans), and electrocardiogram (ECG), may be ordered to confirm the diagnosis and determine the underlying cause of the patient's symptoms.

Once the diagnosis is confirmed, the appropriate treatment plan is formulated. This may include rest, physical therapy, medication, and in some cases, surgery. The treatment plan is tailored to the individual patient's condition and may involve a multidisciplinary team of healthcare professionals, including physicians, nurses, physical therapists, and surgeons.

Throughout the patient's treatment journey, close monitoring and evaluation are essential to ensure the effectiveness of the treatment and to identify any potential complications. Regular follow-up appointments with the healthcare team are scheduled to assess the patient's progress, adjust the treatment plan as needed, and provide ongoing support and guidance.

In conclusion, this case study presents a 77-year-old man who calls for help with severe backache. The paramedics arrive promptly to assess the patient's condition and initiate treatment. The diagnosis of acute lumbar spine pain is made based on the patient's history, examination findings, and initial investigations. The treatment plan is tailored to the individual patient's condition and may involve a multidisciplinary team of healthcare professionals. Close monitoring and evaluation are essential throughout the treatment journey to ensure the effectiveness of the treatment and to identify any potential complications.

Weight: 780g
Dimension: 245 x 174 x 20 (mm)
ISBN-13: 9781032151373
Edition number: 2 ed