Case Study

[getoverit]

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?

[blondy2061h, MSN, RN]

He's not septic.

You can be septic with no growth with viral or fungal infection.

[getoverit, BSN, RN, EMT-P]

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.

[CaseManager1947]

This was very interesting... I like these Case study postings.

[TA123]

good case study..i was on track too eventhough i did response