Case Study: Fever - Page 2Register Today!
- Jun 23 by jadelpnQuote from blondy2061hYoung, relatively usually/historicaly healthy guy 87 a tad on the low side., unless there's some fasting involved.I'm curious on a BNP and a d dimer, but I'm definitely thinking infectious. I'd anticipate bipap being added if he's still working hard on hi-flow NC and possible prepare for intubation if things don't turn around. Jadelpn, why is a glucose of 87 glaring at you?
- Jun 23 by SwansonRNAgreed, his glucose is fine. Especially when you consider that he probably has been fasting (not feeling well, working hard to breathe). Also his PCO2 is not high (maybe you were looking at his PO2 instead). 36 is actually on the lower range of normal, which makes sense because he is tachypneic. So we know that this isn't a ventilation problem, it's an oxygenation problem. Why is he hypoxic on 100% FiO2? I'm anticipating that he'll need to be intubated. Maybe we could try turning up his flow on the high flow for a little PEEP, but I think we're running out of options. I guess we could try NIPPV as long as he can manage his secretions. Overall I think he'll probably need a bronchoscopy, so intubation is looking like the best idea to me.
As for a diagnosis? For some reason the eosinophilia caught my eye, which is making me think fungal/parasitic, maybe even toxin related. What about carbon monoxide poisoning?? With the headache, flu-like symptoms and hypoxia?
- Jun 23 by uRNmywayMy first thoughts were TB, or influenza? Was a LP done?
Completely agree that he seems to be starting to CTD. BiPap and intubation seem likely. Also, since pulmonary embolism seems possible, prepare for IV heparin/sc lovenox? Not sure if still acceptable treatment for this, but it was last time I was working in an acute setting lol.Last edit by uRNmyway on Jun 23
- Jun 23 by Nurseboy1I think Rolando is on the quick path to intubation. Bipap doesn't seem that it will likely be beneficial given his hypoxemia and most likely has an underlying process that will resolve over days rather than hours. I wonder about contacts with animals. I really wonder about viral etiology something like hantavirus that is endemic to the area and presents with fever and respiratory failure.
- Jun 23 by danceyrunI'm (only) a student but I too was thinking lymphoma or fungal infection. My first thought before seeing the CXR was HIV or another STD.
- Jun 23 by jadelpnEh, 80 is the low side of normal for glucose, so it caught my eye. And I know absolutely little about ABG's, but not in my normal practice. And yes, Sara, PO2--
He is not oxgenating well--
Legionairres is a good thought too. Lymphoma, fungal infection also good thoughts...
Was a CT of the chest done, and what did that show?