I was taking care of a pt. 38 y/o WM who has been incarcerated for around 20 years brought into ER two days ago with high fever and decreased LOC and had a seizure at the prison he was at. Fever waas 101.8 which was brought down by tylenol 650mg rectally q6h prn temp >101.0 took tow doses and he was put on 0.9% NS @ 70cc/h. Cat scan was negative, CXR was normal. V/S in Er and once he was admitted have remained normal except for the two high temps and now they have been running 97.9 F to 98.9 F V/S are Spo2 98% on RA, BP- 136/82, P-78, R- 18. Lungs clear, BS active in all 4 quads, S1 + S2 wnl, no gallop or mumur heard, EKG shows Sinus Arrythmia, lab work all WNL, no elevated WBC , BS was 108 in ER, no hx of IDDM or DM. Pt.. has hx of epilepsy since he was born on Depakote 250mg PO BID. Pt. is still two days later disorienteted, doesn't know where he is , why he is @ the hospital or anything, or even his name. Pt. also has a foley and is putting out clear, yellow urine. Blood cultures are negative @ 48 hours, Urine cultures are negative @ 48 hours growth. Doc did a LP and it is normal, nothing wrong there. The Doc os thinking of West Nile virus, bt he isn't for sure, so he is getting ready to transfer him to a Level one Truama/Teaching hospital via ambulance with ALS today. Let me know what yall think about what might be going on with this pt. :confused:
Thanks David