M2 ANATOMY

You are a medical resident on an “away rotation” serving in an underserved rural community. The clinic you are practicing in is understaffed and has a lack of many basic necessities. Regardless, it has been your pleasure to assist this patient population in any way that you can. Today, while you are seeing patients, one of the other staff physicians calls out for immediate help in an adjacent room. You rush over to help, and are confronted with an unconscious patient, lying on the examination table, who is a 63 year-old man. As you observe, the other healthcare providers explain that the routine physical exam was uneventful until one of the other staff physicians performed a rectal exam on the patient with latex gloves. Shortly after the rectal exam, the patient complained of the rapid onset of full body itching, nausea, lightheadedness, flushing, and shortness of breath. The patient was told to lie down, and a physical exam revealed a heart rate of 110 bpm, blood pressure of 90/45, a respiratory rate of 30, and wheezing noted on lung auscultation. Following the physical examination, the patient rapidly lost consciousness. 

You are directed to help in the introduction of fluids to help recover the patient’s blood pressure. You start the placement of two large bore IVs in the patient’s median cubital veins. On visual inspection of the patient, you notice a lack of a normally visible vein that crosses over the sternocleidomastoid m. in the anterior neck. You also feel for a pulse in the carotid triangle and note it is very weak but rapid (thready).