A few months ago we had a case study presentation of a cardiac episode in the ER and I was wondering if anyone was interested in another one? I'll try to present this one as best I can (I've never done this before) and I'm sure you smart cookies will figure this out pretty quick.
A 64 y.o. male admitted with acute mental status change and fever. His vitals are:
HR 127 intermittent a-fib/sinus tach
BP 146/62
RR 28
SpO2 94% on 5L/NC
He is restless and confused. The neurologist was unsuccessful at obtaining an LP so he was started on Acyclovir empirically. After several days, you notice his urine output is markedly decreased (+2L I&O). His heart rate has been controlled with Metoprolol and Diltiazem and he has been NPO, receiving Heparin,Travasol and lipids through a central line. He is becoming dyspneic on 35% venturi mask and developing peripheral edema. SpO2 has dropped to the mid 80s.
What would you want ordered? What do you think are the best actions to manage him?
You're right, you can be septic without growth but I was just saying that he wasn't septic. Not a blanket statement.
This gentleman had developed acute crystal nephropathy from Acyclovir. He subsequently developed ARDS, began going in and out of v-tach and DIC. To compound this he also developed an ileus.
His case continues with a bleak prognosis. I thought he was a very interesting and unique case.
blondy2061h, MSN, RN
1 Article; 4,094 Posts
You can be septic with no growth with viral or fungal infection.