My ED cases

صباح الخير نرجعلكم وي كيس لطيفة Young age patient presented with severe episodes of vomiting for 1 days duration الفكرة انه مرات البرزنتيشن شي والكزامنيشن شي ثاني Young male pt with hx of abd pain tx as Lymphadinitis presented with vomiting and and pain mainly epigastric 7/10 on painscale No hx of smoking or alcohol, sick contact, travel or bloody fbm Upon primary survey ABCDE intact Vitals were Bp 150/90 Spo2 98 Pr 123 FSG 112 PMH of tramal addiction which treated 15 days ago in a rehabs PSH negative Social -ve Pt started on analgesia ( we needed Morphine to control the pain), antiemetic, supportive and NPO Sent for cbc bmp abg sr amylase, lipase, lft, erect abdomen, ecg Pain become 2/10 no vomiting Upon taking further hx pt reported feeling of neck fullness from this morning While completing secondary survey fullness , change in voice and cribitus in the neck and chest Soft abdomen with mild tenderness Labs normal Abdomen US only reacted L.N Sent for chest xray which show subcutaneous emphysema This case turned to a suspected case of boerhaarve syndrom CT chest sent with contrast which confirm the diagnosis and admitted to CTV ward This case consider mild and treated conservatively with abx fluid NPO and follow up