Howdy friends, and welcome back to another exciting installment of Diagnose This! We have been doing this segment for about 10 weeks now (*gasp*) and have heard only positive reviews, so fingers crossed the next 10 will be even better!
Now, last week we were confronted with a daunting situation: a patient in shock, rapidly deteriorating and needing a quick-thinking doctor (that’s you!) to figure out how to help. The acronym used is ABCDE: Airways, Breathing, Circulation, Disabilities, Exposure. This is called the primary survey, and should be of the utmost importance when dealing with patients in this kind of situation. The type of shock in this patient is septic shock. Reasoning behind this; 1. Post op patients are more likely to develop sepsis and thus septic shock and 2. the patient is febrile. These two should be enough to come to that conclusion, so management would involve obtaining a blood culture to determine the causative agent. Now, treatment was a little bit more difficult this week, what with the dosages and what not. We were looking for 1L of crystalloid solution to be administered in 10-15mins, with reassessment of the blood pressure determining if continuing fluid resus, lowering the volume to 500ml/hr, or trying more drastic measures should be considered. Obtaining a blood culture should be done before the administering of broad spectrum antibiotics (flucloxacillin 2 g IV, 6-hourly PLUS gentamicin 4-7 mg/kg IV, for 1 dose).
There are other things to consider, but alas I don’t want to rant and make people sick of this series! If you have any questions please message the bloodbonesandbodies official Facebook page.
Now, onto the next case!
A patient presents to the ED complaining of central pleuritic chest pain, roughly 15mins apart and only brought on when coughing. He appears quite jaundiced, and admits to having both dark urine and pale stools. Interestingly, on a full examination, you notice that he has pallor of the palms and appears breathless.
FBE shows the marked reticulocytosis and lowered haemoglobin, with an increase in unconjugated bilirubin in the blood.
What is the main diagnosis to be considered? What treatment is there for this condition? And what are the main causes of this condition?
Find out next week on Diagnose This, brought to you by bloodbonesandbodies.
Liver disease has been documented throughout the ages, with even the Ancient Egyptians showing evidence of this little bugger (Schistosoma haematobium) hanging out in their livers!
Image credit: http://dolinabiotechnologiczna.pl/nowe-doniesienia/mikrobiologia-nowosci/genom-schistosoma-haematobium-opublikowany/