Okay, not an argument, really, but we're working on a group project and one member is sticking with a different answer from the rest of us. That's totally fine by us, it won't affect the grade. But I'm having trouble understanding the reasoning.
A 20-year-old college rugby player is brought in to the ER. During a match, he took a hit. He was slow to get up and his neck is stiff. The headache is much worse. His left hand is now numb and cold. His team mates say he just isn't acting like himself so they brought him in. His roommate says he overslept, was acting kind of sluggish before the game, and complained of a headache, but blamed it on over indulging at a party in the dorms the night before. While waiting for the results of the lumbar puncture, he begins seizing.
An assessment gives the following results:
temp 39.5 C
resting heart rate 110 beats per minute
respiratory rate 30 breaths per minute
X-rays - negative for skull fracture
negative for cervical vertebrae fracture
hyporeflexia
Left hand is pale and cold to the touch.
CSF analysis:
pressure 210 mm H20
color turbid
proteins 49 mg/ dl
glucose 42 mg/dl
WBC's 580/mm3
We say meningitis, probably bacterial. The WBCs alone indicate wicked infection, but add the pressure, turbidity, seizure, and behavior BEFORE the hit and we see infectious disease, rather than trauma. That's leaving out the cold, pale hand (perfusion issue due to septicemia, we suspect). I can't remember if brain trauma can affect resp rates or not, but I suspect it can, so that and heart rate aren't necessarily indications of infection vs trauma. But there's enough *other* stuff... I guess it just seems fairly clear-cut to the rest of us. I love that she's sticking to her guns, though. TBI was actually my first thought, but when I reread the question, there were more clues pointing to infection than trauma that I changed my mind.
I'm not looking for your agreement so much as more understanding of her POV. Would anyone else say TBI instead of meningitis? Why or why not?
Thanks! I'm so loving this class, I can't stand it, even though it's kicking my butt. :chuckle
Yeppers! She expects to have final grades Sunday night, barring infernal computation device issues (hers and mine, my motherboard is on the fritz). But if all goes well and we both have functioning computers, I'll put it up asap.
I totally love Roueche. Do you remember which one you read? I think Eleven Blue Men is my favorite. For neuro stuff also, Oliver Sacks (*sigh*) is wonderful. He has a great writing style and boy does he know his stuff. Lots in the New Yorker, and a bunch of books on his own.
Yeppers! She expects to have final grades Sunday night, barring infernal computation device issues (hers and mine, my motherboard is on the fritz). But if all goes well and we both have functioning computers, I'll put it up asap.
OK, So we can expect an answer Sunday night. Now don't be tardy, or we'll have to deduct points from your grade :)
I totally love Roueche. Do you remember which one you read? I think Eleven Blue Men is my favorite. For neuro stuff also, Oliver Sacks (*sigh*) is wonderful. He has a great writing style and boy does he know his stuff. Lots in the New Yorker, and a bunch of books on his own.
I read Medical Detectives by Roueche. I love Oliver Sacks, too!
For my 50th birthday, my husband bought me a bunch of medical history/medical case books. I've been working my way through them and having a blast! The very first medical history book I ever read was Steven Johnson's Ghost Map. I was totally hooked. In fact, I did my microbiology presentation on cholera. :)
You've probably already read this, but for those who haven't, Atul Gawande's long article, The Itch is amazing and fascinating:
$%&&_)(&$@!@*(!!! Apparently something went wonky with the system as she was getting to the last two groups' work (of course we're the last of the two). She hopes to have it resolved today, so I'll have my grade and you'll have her answer.
FWIW, so far the class has a 75% average. Eep. Most are nestled between 75-100%, though, so that's got me hoping.
cmonkey
613 Posts
Yeppers! She expects to have final grades Sunday night, barring infernal computation device issues (hers and mine, my motherboard is on the fritz). But if all goes well and we both have functioning computers, I'll put it up asap.
I totally love Roueche. Do you remember which one you read? I think Eleven Blue Men is my favorite. For neuro stuff also, Oliver Sacks (*sigh*) is wonderful. He has a great writing style and boy does he know his stuff. Lots in the New Yorker, and a bunch of books on his own.