Elevated Temp

[Frozennoodle]

56 yoa male patient found lying supine in bed A&O x4 with a GCS of 15 c/o elevated temp weakness and dizziness. Patient advises fever began the day before with increasing temp and weakness leading up to call and that this is the second time he has called for EMS transport and hospital treatment in a week for the same complaint. Patient advised he was laying in bed all day. Patient advised -SOB, -N/V, -Chest pain with +weakness and +dizziness.

NKDA, PMHx: ETOH, HTN, Anxiety, Insomnia, Depression. Ate breakfast around 0800 call was around 1700 pt hadn't eaten or drank anything since then.

Vitals: 118/68 mmhg, 132 HR, RR 24 and non-labored, 91% RA, 192 CBG, Temp 102.8

Physical exam reveals =cbbs, hot dry red skin, strong regular radial pulse.

Patient placed on 4LPM O2 via NC and 18GA IV started in left forearm 1/1 attempts successful with -swelling, -coolness, -pain on flush and saline lock applied. NS bolus administered 250CC with and additional 100CC's run throughout transport.

Vitals: 122/70 mmhg, HR 117, RR 20 and non-labored, 97% 4lpm, temp 99.9

=CBBS present after bolus. Patient advised decreased weakness and dizziness after treatment. Patient care and report given to facility staff.

Total transport time roughly 25 minutes.

 

[MrBrown]

Your lingo is very hard to understand. What do NKDA, =CBBS mean?

Sounds like he has an infection, with a BGL of 190 (~11mmol/l) he is just on our very high side of normoglycaemic. Does he have any history of diabetes?

Has he been coughing up anything? has he actually vomited and if so when and what? diarrhoea? what did they do at the hospital last time? what do his lungs sound like?

Brown thinks he has a chest infection and would most likely recommend he eats something and goes to the medical centre or his GP. Brown wouldn't really be inclined to transport him unless he either a) absolutely insisted and made a scene, b) has no GP or c) can't afford the medical centre

 

[TransportJockey]

If NKDA is the standard, it means 'no known drug allergies' I'm assuming CBBS means clear bilat breath sounds... but I've never seen that one.

 

[Frozennoodle]

Your lingo is very hard to understand. What do NKDA, =CBBS mean?

Sounds like he has an infection, with a BGL of 190 (~11mmol/l) he is just on our very high side of normoglycaemic. Does he have any history of diabetes?

Has he been coughing up anything? has he actually vomited and if so when and what? diarrhoea? what did they do at the hospital last time? what do his lungs sound like?

Brown thinks he has a chest infection and would most likely recommend he eats something and goes to the medical centre or his GP. Brown wouldn't really be inclined to transport him unless he either a) absolutely insisted and made a scene, b) has no GP or c) can't afford the medical centre

Sorry about that, Brown.

=CBBS - equal clear bilateral breath sounds
NKDA - No known drug allergies

Nope, No history of diabetes, normal bowl movements/urination, no nausea or vomiting, treated for sepsis and released. If it were me I would have called in sick to work and just have been done with it but he wanted to go. I figured sepsis too and given his presentation, lack of fluid intake, and how dry his skin was i figured some fluids would be appropriate if not urgently required especially because he was going to wind up with a line in the ER anyway.

 

[MrBrown]

You are right, this bloke does meet the criteria for SIRS now that Brown thinks about it

*Brown takes foot out of mouth and goes to get the stretcher

 

[usalsfyre]

You are right, this bloke does meet the criteria for SIRS now that Brown thinks about it

*Brown takes foot out of mouth and goes to get the stretcher

I would wager any of us who have had the flu met SIRS/sepsis criteria at one time or another. Doesn't mean oral hydration and bedrest aren't appropriate.

 

[mycrofft]

Sounds like either something simple or something bad.

Not to say simple can't be bad.

The declaration of sepsis treated and released deal bothers me, aded to his age and hx.

Otherwise, based upon objective data, he sounds like he may have something affecting his appetite and has become dehydrated, maybe has some inner ear issues, is drinking alcohol again as an additional insult. (Hx HTN, ETOH [alcohol abuse], sepsis..any meds? Does he live in an oveheated or socially isolated environment? Does he call for transport in the evenings? Could have a psychosocoial component). Sounds like a case of "Done Good" to me.

 

[Melclin]

Seems like he has a reasonable case of being sick.

A tachy of 132 is pretty decent and 118/68 with a hx of htn is probably mildly hypotensive for him. Any idea what his normal BP is?

I think its worth a trip to ED. With anxiety/depression there, he might be inclined not to take the best care of himself if he's left to his own devices. In any case, I think he's too crook to leave at home.

Did he have a productive cough or anything like that?

He could probably have had a bit more fluid. Thing is though, that if its sepsis with a resp origin that fluid might end up in his breathin' bags, although I think we worry about that a little too much in our system. Keep a good eye on his lungs and resp status, and pop a bit more NS in perhaps.

 

[Aidey]

How significant is his history of alcohol abuse? Does he currently drink excessively? If he is normally intoxicated, and wasn't at the time that could contribute to his vitals being off.