Triage: BIBA for AMS & WBC 19.2, 103.5F, Dysuria X 3 days
History of Present Illness: A 60-ish-year-old female with a history of CAD, CHF, hypertension, diabetes, peripheral neuropathy, CKD stage III, and chronic anemia presents with 3 days of fevers, chills, left lower quadrant abdominal pain that radiates to the back and dysuria. She denies nausea, vomiting, diarrhea, shortness of breath, chest pain or other complaints.
Vital Signs: T: 38.2 °C, HR: 89 RR: 15 BP: 124/47, SpO2: 98%
Physical Exam: Seems to have brain fog, A+O x2 which is worse than her baseline. Tender LLQ and L CVA
Initial Diagnostic Testing:
- CBC: WBC 18 with left shift and 20 bands, Hb 9.7
- Chem-7 and UA: Mild DKA with urine positive for bacteria and >1000 WBC/hpf
- Imaging: see below
What does the CT show?
- A) Pyelonephritis
- B) Gastritis
- C) Diverticulitis
- D) None of the above
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>
THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA
- Emergency Medicine 1-Minute Consult, 5th edition
- A-to-Z EM Pharmacopoeia & Antibiotic Guide, 5th edition
- 8-in-1 Emergency Department Quick Reference, 5th edition
******************************************************************************
<<<<<<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>>>>>>>
QUIZ ANSWER:
- A) Pyelonephritis
- B) Gastritis
- C) Diverticulitis
- D) None of the above – CORRECT: She has emphysematous cystitis
1-Minute Consult on Emphysematous cystitis:
- Clinical: Dysuria, pain, pyuria, often septic,
- Tests: UA+, CT shows gas in bladder wall
- Risks: Diabetics, immune suppression
- Top organisms: E coli, Klebsiella or Proteus.
CASE CONCLUSION: urology consulted and recommended Foley drainage; admitted to ICU and started on broad spectrum antibiotics
***