Saturday, June 26, 2010

Pleural Rub

An elderly chinese gentlemen with a background hx of parkinson disease come to the A&E with dyspnea, fever and reduce counciousness since 2 days ago.

On examination he was dyspnoeic with RR of 28 + use of accessory muscle + course crepts + bronchial breath sound + pleural rub over the left upper zone.

What is your differential for pleural rub? - one MO ask...

  • pleurisy - secondary to pneumonia or pulmonary infarction
  • rare - pleural malignancy, spontaneous pneumothorax, pnemodynia
Describe the pt's tone (UL exam)
  • cogwheel / plastic / leadpipe rigidity - ↑ tone with interrupted nature → muscle give way → jerks
  • due to exagerated stretch reflex interrupted by tremor
Assess the pt's GCS score
  • eye - 4
  • motor - 1
  • verbal - 1
  • = 6
A114141

0 comments:

Post a Comment

 
Powered by Blogger