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Altered Young Adult

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A man in his late 20s is brought to the ED for confusion and fever. Per medics roommates say he has been weak for about 5 days with fever and body but today was not acting appropriately. He admits to a mild headache but denies other symptoms, specifically no chest pain or SOB.

Vital Signs & Physical Exam:

Vital signs are normal except for a fever of 38.5   Physical exam is otherwise normal except for mild to moderate confusion

Initial Diagnostic Testing:

  • EKG: none
  • Labs: tox all negative.  WBC 7.1 but 85% PMN’s
  • Imaging: a CT scan is done

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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ANSWERS:

  1. What does the case image show?  The image shows multiple hypodense intracranial lesions. Further evaluation with dedicated enhanced MRI was recommended.
  2. What should you do next?  Treat with IV antibiotics, admit, consult ID
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

CLICK HERE TO LEAR MORE ABOUT THIS BOOK

CASE CONCLUSION: Blood cultures grew out S. aureus in 2/2 bottles at 12 hours

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