Case 15 – History


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Case 15

Chronic pain and sudden death


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Brief Past Medical History

The patient was a middle-aged Caucasian man with chronic pain related to a work injury to the right wrist approximately 10 years prior.

A wrist surgery did not relieve his pain.

He was managed with multiple pain medications.

“Ganglion” injections of the neck also did not help his pain.

He complained of ongoing pain, was unable to work and became depressed.


Premortem drug testing approximately 1 year prior to death


Part 1

Part 2

Part 3


Perimortem events

The patient died suddenly after an unwitnessed cardiopulmonary arrest.

The family states he did not take any pain medication on the day of death or the night before he died; but did take pain medication the morning of the day before death.


Next: External exam

Discussion Questions

1. Summarize the history.

2. What type of fluid does the toxicology test?

3. Interpret the toxicology test. Would you make any changes or advisements to the patient as their clinician?

4. What is a differential diagnosis for why this patient might have died?