Clinicians should always consider capturing images with their phone when possible so that key clinical findings seen in the real‐time physical examination can be memorialized in the electronic medical record.
Long‐term abuse of nasally inhaled substances such as heroin can result in life‐threatening hypersensitivity pneumonitis and respiratory distress. In the setting of hypoxia, a chest CTA is often necessary to see the extent of the lung involvement and to rule out pulmonary emboli.
Background
A female patient known to have schizoaffective disorder self‐presented to an emergency department in a state of acute agitation and paranoia shortly after a 35‐day inpatient stay at a psychiatric facility.
Case report
The patient exhibited no signs or complaints of dyspnea or hypoxia, but later collapsed and became hypoxic after sleeping comfortably with sedation for 12 h in the psychiatric unit. She was intubated and a computed tomography angiogram revealed bilateral lobar pulmonary emboli and right heart strain.
Conclusion
Psychiatric hospitalizations, medications, diagnoses and relevant sequelae increase venous thromboembolism risk more than many realize.
While CT scans without IV contrast are obtained commonly to evaluate vertebral injuries, CT angiography scans should be considered whenever a fracture site approaches known vasculature.
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