Previously healthy 28 y/o male presents with acute bilateral | Figure 1

Patient Case Summary

Patient Demographics: 28 y/o male

Chief Complaint: Acute bilateral limb ischemia.

History of Present Illness: 28 y/o male presents to the ED via EMS c/o chest, back, abdominal pain and bilateral lower extremity pain and paralysis. 90 minutes prior to arrival, he was at rest in his home, having a drink and waiting for his wife. He suddenly experienced a fluttering sensation in his throat, which rapidly progressed to severe chest, back, and abdominal pain, along with urinary incontinence. He attempted to get up but was unable to move his bilateral lower extremities.

ED Arrival: On arrival in the ED, he was alert and oriented, mentating normally with intact cranial nerves but in severe pain.

• Radial Pulses: Bounding left radial pulse, weak, thready right radial.
• Movement: Able to move bilateral upper extremities.
• Blood Pressure: Left arm 168 systolic, right arm 127.
• Chest Auscultation: Normal.
• Abdomen: Mildly distended with audible aortic pulsation; no obvious pulsatile mass or other mass found in this young athletic male; generalized abdominal tenderness with no peritoneal signs.
• Lower Extremities: No obvious deformity; unable to palpate dorsalis pedis, posterior tibial, or bilateral femoral pulse; registered no sensation, even to sharp stimuli; capillary refill was 7 seconds.

Past Medical History: No chronic medical problems.

Surgical History: Negative.

Social History: 1 pack per day smoker, daily alcohol intake recently increased; denies drug use.

Family History: Mother recently passed due to unknown cardiovascular issue.

Additional Cases

Case 1

Patient Demographics: 56 y/o male Presentation: Acute sudden onset mid-substernal chest pain radiating to the back. Found by paramedics clutching his chest and diaphoretic. Severe distress with bounding radial pulses and pale, cool feet bilaterally.

Case 2

Patient Demographics: 67 y/o male Presentation: Severe upper-back pain, tearing in nature, associated with abdominal pain. History of hypertension, dyslipidemia, and type II diabetes mellitus. CT revealed a Stanford type B aortic dissection.

Case 3

Patient Demographics: 63 y/o male Presentation: Seated in a dialysis chair, severe lower back pain, history of hypertension, diabetes, end-stage renal disease, and repaired abdominal aortic aneurysm. Vitals: HR 110, BP 260/140, RR 24.

Case 4

Patient Demographics: 52 y/o male Presentation: Chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. History of hypertension, long-term smoking. EC performed in the primary care setting before referral to the ED.

Case 5

Patient Demographics: 28 y/o female Presentation: 3-day history of intense pruritus over the lower back, care for a small kennel of rescued dogs, multiple small vesicles on physical examination.

Case 6

Patient Demographics: 4-month-old male infant Presentation: Skin lesions localized to the chin; physical exam revealed small pustules with surrounding inflammatory signs.

Case 7

Patient Demographics: Patient in late teens Presentation: Collapse without chest pain, family history negative for sudden death. Evaluation of EKG features in pediatric patient context.