Medical. : Medicine.

Muppet

Paratrooper
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I know there is a subject on Combat Medicine but it is broad subject matter. This is a place where we can discuss and learn things regarding the Military way v/s. the civilian way. I am open to comments and help on how to make this a educational group.

F.M.
 

TLDR20

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We could always do some case studies/things we have seen and lessons learned. Improving skills/knowledge can never be a bad thing.
 

HeloMedic1171

Witch Doctor
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HEY!!!!! I guess no one wanted the resident Flight/stepchild medic to play? geez... I feel like the nerdy white kid who got picked last on the playground.... :(

assholes!! :D


bring on the scenarios!!
 

Muppet

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Don't cry bro. I love you bro.

Call:
35 y/o female, Cao x 4, obvious distress with the C/C: S.O.B./hoarse voice and dysphagia with a h/x of a tooth infection, bottom Lt. row. Pt. is tachycardic, normotensive, febrile with obvious edema and hardness of sub-mandiblar tissues noted over mandible and unable to open mouth fully.

Diff d/x. and treatment (E.M.S.) and 18D level please.

Had this call the other night.

F.M.
 

HeloMedic1171

Witch Doctor
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it's an abscess, and it's definitely infected. On assessment of the oropharynx what do you see? also, approx which tooth was the infected one? I suggest an I&D of the Abscess followed by Augmentin 500mg PO TID for 10 days.
 

HeloMedic1171

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Ludwig angina (name derived from sensations of choking and suffocation) is characterized by brawny boardlike swelling from a rapidly spreading cellulitis of the sublingual, submental, and submandibular spaces with elevation and edema of the tongue, drooling, and airway obstruction.3 The condition is odontogenic in 90% of cases and arises from the second and third mandibular molars in 75% of cases.3 If infection spreads through the buccopharyngeal gap (space created by styloglossus muscle between the middle and superior constrictor muscle of the pharynx), potential exists for adjacent retropharyngeal and mediastinal infection
 

HoosierAnnie

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OK Guys: try this one on.

Run call: 58 yo fem cc: left sided sub costal pain radiating up towards axilla. VS: 156/88 P 96 R 24 Let's do it from the beginning. What info do you want before you make a differential dix?
 

HeloMedic1171

Witch Doctor
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uh, shit. without cheating and using google...

mech of injury? Onset? Provocation? Quality? Severity? Time/duration? Interventions? "Ma'am, do you have any previous history of heart problems or chest pain I should know about? what about surgeries? any recent or past surgeries? are you taking any medications, any over-the-counter meds, supplements, vitamins, anything? do you drink or smoke?"

I'd start with those. :D whatcha got?
 

HoosierAnnie

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Yes Helo, w/o using google (you dont have google in the field do ya??)

Sudden onset while doing routine housework. Onset within past hour. No hx of cardiac/ HPB. Only surgeries childbirth over 20 yrs ago. Light social drinker, lifelong non smoker. Takes a daily multi vit and has been on low dose HRT for the past 6 mos. for perimenopausal symptom control.
 

HeloMedic1171

Witch Doctor
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I wasn't asking if I could use google ... I was telling you I wasn't going to, silly! and no I don't have it in the field, but in fairness, I don't have 58 y/o females in the field, either!! :D

Provocation? Quality? Severity? does respiratory exchange cause pain? or is the pain separate from that? any other symptoms: NVD, dizziness, etc?

I'm not gonna lie, this is quite a bit out of my norm and comfort zone, but I'm glad for the practice.
 

HoosierAnnie

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yes the pain increases on deep inspiration no NVD no dizzy

This isn't a problem of just females, its right out of the Special Forces Med Handbook, I just made your patient female for fun.
 

HeloMedic1171

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k - how about inspection/palpation/auscultation/percussion of the chest and axilla? is the L chest wall TTP? any erythema/ecchymosis? deformities?
 
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