Patient with Blurred Vision and Bilateral Leg Pain

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NOTE: incomplete file

Chief complaint:

A 56 y.o. African American male presents to the ER with blurred vision, bilateral leg pain and respiratory distress.

Patient History:

Diabetes Mellitus.

Differential dx:

Acute asthma bronchitis.

COPD.

CHF.

Final dx:

Acute asthma bronchitis.

COPD.

CHF.

Cardiomegaly.

Tests:

Venous Doppler is normal.

D-Dimer (fibrin degradation product used to diagnose DVT); (results are due).

Comprehensive metabolic panel (repeat daily).

Patient refused V/Q scan (can't lie flat).

X-ray reveals cardiomegaly.

Physical Examination:

Peripheral edema.

Blurry vision present.

Current Medications:

Lasix/Furosemide/loop diuretic (Ordered by ER physician).

Ecotrin/Aspirin/acetylsalicylic acid (Ordered by ER physician).

Morphine (Ordered by ER physician).

Atrovent/Ipratropium (anticholinergic drug that blocks muscarinic cholinergic receptors) (Ordered by ER physician).

Insulin (Ordered by ER physician).

Captopril (ACE inhibitor) (Ordered by FP physician).

Digoxin/cardiac glycoside (cardiac action potential and decreased K+ conductance) (Ordered by FP physician).

Dopamine/vasopressor agent (to increase cardiac output and organ perfusion) (Ordered by FP physician).

Lasix (Ordered by FP physician).

Actos/pioglitazone (to improve glycemic control) (Ordered by FP physician).

Glucotrol/glipizide (sulfonylurea used to improve glycemic control) (Ordered by FP physician).

Protomix (proton pump inhibitors used to reduce gastric acid production) (Ordered by FP physician).

Spironolactone (K-saving diuretic) (Ordered by FP physician).

Vasotec/Enalapril (ACE inhibitor) (Ordered by FP physician).

Heparin (Ordered by FP physician).

Avelox/Moxifloxacin (a fluoroquinolone that blocks DNA unwinding and replication) (Ordered by FP physician).

Albuterol (short-acting alpha agonist used for acute asthma) (Ordered by FP physician).

Bactroban (mupirocin; used to treat skin infections) ointment to nares (Ordered by FP physician).

Miscellaneous Notes:

Cardiomegaly due to opioid abuse.

Pericardial Effusion.

Can't lie still.

CMP results improving.

Additional Reading:

Interesting Case Histories

1. Patient with Blurred Vision and Bilateral Leg Pain
2. Patient with Abdominal Pain and Gas

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