Clinical Cases: Tension Pneumothorax and Missed CHF Exacerbation

People involved professionally in medical education (CME administrators, journal editors) sometimes ask me if there is any value in information posted on medical blogs since most blogs are "one-man show" and data is not independently verified. These points are valid but I believe some blogs can enhance the educational experience by providing unfiltered, real-life description of clinical cases which will rarely be found in medical textbooks. See two examples below:

Bread and Butter. M.D.O.D.
Heart of 140 bpm was the key that something more was going in this young man with chest pain who turned out to have a potentially life-threatening tension pneumothorax. We had a patient with unexplained sinus tachycardia in 120s on our inpatient service and although her pneumonia was getting better, I insisted on further investigation to look for underlying cause of tachycardia. TTE was normal but TEE showed large aortic valve vegetations and valve perforation which required a surgical repair. Vitals signs are called like that because they are truly of vital importance.

Related:
Clinical Cases and Images: Tension Pneumothorax.
The Pressure Is On. The Happy Hospitalist, 02/2008.

Dyspneic. DB’s Medical Rants.
Robert Centor describes a case of CHF exacerbation which was mislabeled as COPD exacerbation. A focused physical examination (and a BNP of 1300) helped make the correct diagnosis.

Related:
Clinical Cases and Images: COPD vs. CHF Exacerbation.

Updated: 03/01/2008

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