Hx 47 yo Asian male. NMPHx, no meds, allergies ect. Basically a healthy male that has not been out of the country for 6-7 years.
3-4 months prior pt spiked a high fever~40C, it only lasted for a day and went away(unknown if pt had any other S/S during this time)
Pt comes into ER today, ambulatory with GCSx15 C/O fever x1 day, again ~40C. 2-3 hours later pt was intubated, 6 hours after admitance to the ER pt coded for the first time.
We ended up working the Pt for over 2 hours. Everytime we got a pulse back he was very tachy, the first time it was in the 180's, and everytime after it was in the 140's(which im sure was because of all the sympathomimetics dumped into him) Basically everytime he came back, he would be ok for ~5-10 minutes and his H.R. would slow down, eventually into PEA in the 110-130's.
Pt ended up with 7 or 8 liters of NS, 4U of blood and 2-4 of plasma. Zero urine output in this time. During the middle of the code, Levophed, Dopamine, Vasopressin, and EPI were all running on a drip at the same time, on top of the 1mg EPI being pushed every 3-4 minutes. Pt also got lots of bicarb during this time.
In the last 30-45 minutes the pt began having DIC(i guess thats how its used in a sentence) and eventually lost 1-2 liters of blood through the ETT.
The docs thought it may have been a bowel obstruction, although the pt was incontinent. Chest x-ray showed a "haziness" that led them to believe he possibly had a staph infection in his lungs.
Any other ideas? I find it hard to believe that a pt became septic and died within one day from a bowel obstruction, even if it was perforated, i dont see it happening that fast. Not to mention there was no melena or hematochezia.
P.S. sorry if this was scattered out, i was just trying to cover all my bases.
3-4 months prior pt spiked a high fever~40C, it only lasted for a day and went away(unknown if pt had any other S/S during this time)
Pt comes into ER today, ambulatory with GCSx15 C/O fever x1 day, again ~40C. 2-3 hours later pt was intubated, 6 hours after admitance to the ER pt coded for the first time.
We ended up working the Pt for over 2 hours. Everytime we got a pulse back he was very tachy, the first time it was in the 180's, and everytime after it was in the 140's(which im sure was because of all the sympathomimetics dumped into him) Basically everytime he came back, he would be ok for ~5-10 minutes and his H.R. would slow down, eventually into PEA in the 110-130's.
Pt ended up with 7 or 8 liters of NS, 4U of blood and 2-4 of plasma. Zero urine output in this time. During the middle of the code, Levophed, Dopamine, Vasopressin, and EPI were all running on a drip at the same time, on top of the 1mg EPI being pushed every 3-4 minutes. Pt also got lots of bicarb during this time.
In the last 30-45 minutes the pt began having DIC(i guess thats how its used in a sentence) and eventually lost 1-2 liters of blood through the ETT.
The docs thought it may have been a bowel obstruction, although the pt was incontinent. Chest x-ray showed a "haziness" that led them to believe he possibly had a staph infection in his lungs.
Any other ideas? I find it hard to believe that a pt became septic and died within one day from a bowel obstruction, even if it was perforated, i dont see it happening that fast. Not to mention there was no melena or hematochezia.
P.S. sorry if this was scattered out, i was just trying to cover all my bases.
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