Author: Seth Camhi, MD, MBA
Co Author #1: Paul Brydon, DO
Co Author #2: Kenneth S. Taylor, MD
Editor: Rahul Kapur, MD
Patient is an 18 yo healthy F with no significant PMH who is a freshman soccer player at UCSD. She had just recently arrived to school and was at a soccer meeting prior to college physicals when she stood up and had an acute onset of umbilical abdominal pain that was associated with a sensation like she was going to have a bowel movement as well as nausea and a sense of vertigo. She then syncopized and fell backward on the concrete from a standing position hitting her head. She briefly lost consciousness and had woken up and was oriented by the time EMS arrived. When EMS questioned her, she was complaining of nausea, vomiting and reported that the room was spinning along with a severe headache. She was then taken to the hospital by Ambulance for evaluation. The only significant precipitating event uncovered after obtaining a detailed history of the events leading up was that she had chiropractic manipulation the day prior by her father who is a chiropractor.
PMH - Negative
PSH - Negative
FH - None
SH - (-) smoke, (-) EtOh, (-) IVDA.
Meds - None
Allergies - NKDA
Gen: AA&Ox3, NAD
Vitals: T: 36.8 C, RR 14, HR 77, BP 125/48
HEENT: NCAT, eyes: PERRLA, EOMI. Initial eye exam in ED: +rotary nystagmus to the left on Left gaze. Ear: clear, TMI - no retraction or fluid. Nose: septum: mild Rt deviation, mucosa healthy, turbinates: healthy. Oropharynx: clear
Neck: Supple, No LAD, no thyromegaly
CV: S1S2, RRR, no murmur
Resp: CTA bilaterally, no wheezing
GI: Soft, non tender, non distended, (+) BS, no hepatosplenomegaly
Ext: No deformities or edema, (+) peripheral pulses
Neuro: CN I - no response to coffee or alcohol. CN II-XII - grossly intact.
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