DogLovingPA Posted January 7, 2016 Share Posted January 7, 2016 Something new to add to your differential diagnosis of left shoulder pain.... 54yo male presents to urgent care for 2 days of left shoulder pain after feeling a "pop" putting on his hunting coveralls. Stable, no other history offered, no alarm s/s. Worked up as musculoskeletal, sent home. Two days later presents to ER c/o of increasing shoulder pain. Story he tells the ER is that that 5 days ago he pulled his own abscessed tooth out with vice grips and bled all over the bathroom. He sprayed bleach to clean it up but fell, hitting his shoulder and caused him to breath in bleach fumes and now his shoulder hurts and he's coughing up phlegm with SOB. Admitted for pneumonia. I'm not sure what transpired in the 24 hours following... but day after admission gets a CT of his neck and thorax showing abscess formation within the inferior left neck extending into the superior mediastinum. Urgently transferred for I&D and now in ICU. Link to comment Share on other sites More sharing options...
RuralER/Ortho Posted January 7, 2016 Share Posted January 7, 2016 Well.... that is a new one.... No reason to mention your at home minor surgical procedure though right? Link to comment Share on other sites More sharing options...
Boatswain2PA Posted January 7, 2016 Share Posted January 7, 2016 I woulda missed that. Link to comment Share on other sites More sharing options...
DogLovingPA Posted January 7, 2016 Author Share Posted January 7, 2016 I woulda missed that. Yeah.... I think the 4th (maybe 5th) provider to see him was the one to catch it. I'm guessing by this point some s/s had developed that made the diagnosis more obvious (swelling of neck, cellulitis, general decline, etc). Link to comment Share on other sites More sharing options...
sk732 Posted January 12, 2016 Share Posted January 12, 2016 He certainly jumped over that fine line between hard and stupid...wouldn't have seen that coming without the little tidbit about the tooth. SK Link to comment Share on other sites More sharing options...
DogLovingPA Posted January 23, 2016 Author Share Posted January 23, 2016 Well, sadly I think his 6 pack a day habit played a roll in his home surgery and lack of recall of the event. The patient is still in ICU (day 16 now) and underwent another surgery today for debridement of a septic left sternoclavicular joint. Link to comment Share on other sites More sharing options...
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