04-27-2004, 12:04
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#1
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JAWBREAKER
Join Date: Jan 2004
Location: Gulf coast
Posts: 1,905
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Indig. child
You are operating a rudimentary field hospital for the local population while performing your UW mission. The next person in line is a mother/child combo with the mother very concerned/frantic over the child's new "illness".
Her English is poor and you can't get much history out of her except the following.
She reports that a big bump has arisen inside the mouth of her 6 yr old child. She is very concerned that this could be deadly as it has arisen in the last 48 hours with no other symptoms.
You get the child to open his mouth.. "abra la boca."
You peer inside with your flashlight/tongue depressor.
You, "¿duele?"
The child, "no"
You see the following.... what might it be (differential DX) ? What do you think is it? What should you do based on your Diagnosis? IS THE PATIENT GOING TO DIE as the mother fears?
? 
Last edited by Sacamuelas; 04-27-2004 at 12:13.
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Sacamuelas is offline
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04-27-2004, 14:17
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#2
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Quiet Professional
Join Date: Jan 2004
Location: LA
Posts: 1,653
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Yes, the patient is going to die - eventually
Was she eating during or right before this?
What does the exterior look like? Any masses visible outside?
Any numbness in the face? Cranial nerves status?
Any weakness in the facial muscles?
Do I have dental X-ray available?
What labs do I have available?
I'll wait a while for my DX.
Good case.
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.
Still want to quit?
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NousDefionsDoc is offline
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04-27-2004, 14:49
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#3
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JAWBREAKER
Join Date: Jan 2004
Location: Gulf coast
Posts: 1,905
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Quote:
Originally posted by NousDefionsDoc with answers folowing by Saca
Yes, the patient is going to die - eventually
very good attention to detail.
Was she eating during or right before this?
Yes, Just some plantains.
What does the exterior look like? Any masses visible outside?
No masses, WNL on exterior
Any numbness in the face? Cranial nerves status?
No numbness reported, CN check tests WNL
Any weakness in the facial muscles?
No.. You asking redundant questions now? You already hinted around and asked CN VII status in your last question. Note: My SmartA$$ reply makes us even for above likely to die answer. LOL
Do I have dental X-ray available?
Yes, I will post one if you think you would have access to this technoilogy on this mission. I will have to find one and post if you want it.
What labs do I have available?
Any standard lab you would normally have access to process... what do you want?
I'll wait a while for my DX.
[Smart man... I think you will be surprised based on your line of questioning master yoda[/i]
Good case.
Thanks
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Any other questions by anyone??? If not, hurry up there Docs... this mom is getting very pissed and nervous that it is taking so long to get that medivac chopper in!!!!! Did I mention that this is the G chief's kid and all the village is now watching!!! LOL
Last edited by Sacamuelas; 04-27-2004 at 14:51.
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Sacamuelas is offline
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04-27-2004, 14:53
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#4
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Quiet Professional
Join Date: Jan 2004
Location: Wherever my ruck finds itself
Posts: 2,972
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No idea...
__________________
"It's better to die on your feet than live on your knees."
"Its not who I am underneath, but what I do that defines me" -Batman
"There are no obstacles, only opportunities for excellence."- NousDefionsDoc
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Surgicalcric is offline
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04-27-2004, 14:54
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#5
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Quiet Professional
Join Date: Jan 2004
Location: LA
Posts: 1,653
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Not redundant, different. How is facial muscle weakness the same as CN status?
No Xray then. And no biopsy.
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.
Still want to quit?
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NousDefionsDoc is offline
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04-27-2004, 14:57
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#6
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Quiet Professional
Join Date: Jan 2004
Location: LA
Posts: 1,653
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I won 't be surprised I don't think. Just ruling out.
I've got it narrowed down to two in my head. With one very much more likely given the patient's age and lack of pain. I don't do well with pics.
What do I feel when I palpate that area and what is the patient's reaction?
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.
Still want to quit?
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NousDefionsDoc is offline
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04-27-2004, 15:02
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#7
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JAWBREAKER
Join Date: Jan 2004
Location: Gulf coast
Posts: 1,905
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Quote:
Originally posted by Surgicalcric
No idea...
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That won't help the even more pissed off wife of the G-chief. Her sobbing has just gotten so loud that NORAD heard it on their ears in Alaska!! haha She is now starting to talk as if the gringos have brought this plague upon the people of the village to sabotage them. She didn't seem to like being told it was so rare a problem that even the "gringo medicine man that drops from the skies" that can cure malaria symptoms and terrible infections doesn't know what it is. LOL
Gotta do or say something... Can anyone out there help? It isn't only the 18D that will catch hell if the G tribe loses faith in the Team.
Guesses? Suggestions?
***edited to correct the good teacher's observation(spelling)
Last edited by Sacamuelas; 04-28-2004 at 08:15.
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Sacamuelas is offline
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04-27-2004, 15:08
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#8
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JAWBREAKER
Join Date: Jan 2004
Location: Gulf coast
Posts: 1,905
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Quote:
Originally posted by NousDefionsDoc
I won 't be surprised I don't think.
What do I feel when I palpate that area and what is the patient's reaction?
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I am not underestimating the great one. I was actually just giving you a MOD to Admin hint in case you were off track.
To answer your question:
Lesion is fluctuant. You possibly feel something boney hard/even sharp underneath upon firm palpation... very limited pain if at all when palpating according to the child.
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Sacamuelas is offline
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04-27-2004, 15:11
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#9
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Quiet Professional
Join Date: Jan 2004
Location: Wherever my ruck finds itself
Posts: 2,972
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Abcess ingrown tooth?
__________________
"It's better to die on your feet than live on your knees."
"Its not who I am underneath, but what I do that defines me" -Batman
"There are no obstacles, only opportunities for excellence."- NousDefionsDoc
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Surgicalcric is offline
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04-27-2004, 15:13
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#10
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Quiet Professional
Join Date: Jan 2004
Location: LA
Posts: 1,653
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Ok, now I'm down to one. I think. I'll wait quietly over here in the corner while Crip, the future 18B, gets the Team run out of the base camp.
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.
Still want to quit?
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NousDefionsDoc is offline
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04-27-2004, 15:17
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#11
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Quiet Professional
Join Date: Jan 2004
Location: Wherever my ruck finds itself
Posts: 2,972
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Ouch. I am hearing that alot lately....first TR and now you. You guys are gonna give me a complex. 
__________________
"It's better to die on your feet than live on your knees."
"Its not who I am underneath, but what I do that defines me" -Batman
"There are no obstacles, only opportunities for excellence."- NousDefionsDoc
Last edited by Surgicalcric; 04-27-2004 at 15:20.
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Surgicalcric is offline
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04-27-2004, 15:20
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#12
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JAWBREAKER
Join Date: Jan 2004
Location: Gulf coast
Posts: 1,905
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Quote:
Originally posted by Surgicalcric
Is the mass soft, tender to palpation?
How about a bit-o-lido around the area and either lance it or excise the abcess with a syringe?
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So you think it is a .............. You called it abscess so I assume you are Dx'ing an infected tooth?
I am not picking on you Cric.. I have retyped my post over and over trying to make it sound non-aggressive, it doesn't seem to read that way though...SO read the following in a " this is just for your information and a thought process for the future" kind of way.
As to your incision Tx without giving your Dx first .... What if it is a hemangioma and you just started potentially life threatening bleeding with your incision? Or is that not likely in this cyst and therefore been ruled out? If you already ruled it out, then I apologize...if you give me the reason WHY you ruled it out.
YOur treatment is valid for some possibles... what Dx(s) would that be a good treatment for?
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Sacamuelas is offline
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04-27-2004, 15:23
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#13
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JAWBREAKER
Join Date: Jan 2004
Location: Gulf coast
Posts: 1,905
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HEY APROF members ... THIS IS NOT STRICTLY A CRIC BASHING EVENT..
ANYONE else can chime in... ask questions... make a guess. Cric and NDD are not the only ones responsible for the 80+ views of this thread so far.
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Sacamuelas is offline
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04-27-2004, 15:25
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#14
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Quiet Professional
Join Date: Jan 2004
Location: Wherever my ruck finds itself
Posts: 2,972
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What, no exploratory surgery?
You and I were typing at the same time on that one. I edited it.
Also I will be the first to admit I have no idea when it comes to oral/dental Dx/Tx. Until now I have never studied it at all.
I also did not take your post that way...
CRIC bashing event huh...I got something for yo ass...
I'll be back after PT.
__________________
"It's better to die on your feet than live on your knees."
"Its not who I am underneath, but what I do that defines me" -Batman
"There are no obstacles, only opportunities for excellence."- NousDefionsDoc
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Surgicalcric is offline
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04-27-2004, 15:31
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#15
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JAWBREAKER
Join Date: Jan 2004
Location: Gulf coast
Posts: 1,905
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BTW- Hint...Hint...
ANYONE reading this board that has kids may run into this situation in their lifetime. It is one of the most common lesions seen in a child's mouth.
Cric-
Did you cut the gums in our example scenario? I need to know whether to blow the diversion demo charges and run for it!! LOL
Or maybe... you have been blessed by all the past 18D angels watching over your shoulder and given the right treatment even though you had no idea what you were treating or why it would help?
first part of the answer...
Patient is SIX years old. Time when certain things start happening in that area. What?
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Sacamuelas is offline
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