![]() ![]() Despite a high-dose infusion of noradrenaline and adrenaline, the patient’s circulatory status continued to deteriorate. ![]() Nine hours after admission, in view of worsening shock, drotrecogin alpha (activated protein C) and vasopressin were commenced. A computed tomography scan revealed multiple small areas of airspace opacification in a perivascular distribution, as well as bilateral extensive lower-lobe consolidation. The patient required intubation and mechanical ventilation 6 hoursĪfter admission, due to markedly deteriorating respiratory function.Īt this time, arterial blood gas results measured with the patient on 100% oxygen were: pH, 7.13 (RR, 7.35–7.45) partial pressure of carbon dioxide (Pa co 2), 52 mmHg (RR, 35–45 mmHg) Pa o 2, 237 mmHg (RR,ħ5–100 mmHg) base deficit, –12.3 mmol/L (RR, –3 to 3 mmol/L) and bicarbonate, 16 mmol/L (RR, 22–33 mmol/L). Subsequently 2 g dicloxacillin was administered intravenously. Initial therapy included large-volume fluid resuscitation, a noradrenaline infusion, intravenous hydrocortisone and empirical intravenous antibiotics (3.1 g ticarcillin/clavulanate, 400 mg gentamicin and 500 mg azithromycin, within 50 minutes of arrival). A chest x-ray showed bilateral multilobar consolidation. Initial investigations showed a predominantly neutrophilic leukocytosis (18.4 × 10 9 cells/L ) coagulopathy (prothrombin time, 20 s activated partial thromboplastin time, 40 s ) thrombocytopenia (platelet count, 59 × 10 9/L ) renal dysfunction (urea level, 14.2 mmol/L creatinine level, 172 μmol/L ) and an elevated serum troponin I level (1.4 μg/L She had tenderness in the right upper quadrant the spleen was not palpable. She was febrile, with a temperature of 38.2 ☌, and had a furuncle on her left elbow. Rate, 160 beats/min), hypotensive (blood pressure, 80/50 mmHg)Īnd hyperpnoeic (respiratory rate, 32 breaths/min), with an oxygen saturation of 100% on a non-rebreather mask with oxygen flow atġ5 L/min. When examined on admission, the patient was tachycardic (heart She and other family members had a history of recurrent furunculosis. There was an erythematous lesion on her left elbow. She had also developed a dry cough and anterior pleuritic chest pain. She presented again 2 days later with back pain, increasing shortness of breath, vomiting, myalgia, fever and sweating. Inexplicably, she was discharged with a diagnosis of mechanical back pain. She had normal blood pressure and 100% oxygen saturation breathing room air, but her heart rate was 110 beats/min and she had a temperature of 38.4 ☌. Statistics, epidemiology and research designĪ 23-year-old woman presented to the emergency department with acute radicular lower back pain that became apparent when she was lifting books.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |