Triage: c/o L flank pain, sudden onset one hour ago.
History of Present Illness: A man in his mid 60’s presents with left greater than right flank pain starting around 5 PM yesterday. Does not radiate anywhere. No fever chills or vomiting but does feel lightheaded. No other complaints. No history of same.
Vital Signs: T: 36.8 °C, HR: 96, RR: 20, BP: 122/75, SpO2: 97%
Physical Exam: slightly diaphoretic, left CVA tenderness, otherwise normal
Testing:
- Imaging: CT abdomen/pelvis with contrast and CXR both normal
- UA/Vital: UA normal, but COVID +
- Chemistry: Na 132, albumin 2.9
- CBC: WBC normal but 9 bands and vacuoles present as well as metamyelocytes none of which are flagged
In addition to the HR >90, which of the following are red flags for sepsis? (may select more than one)
- PMN% >70 on CBC
- albumin <3.5 on chem 10
- sodium <135 on chem 10
- vacuoles on CBC
- Dohle bodies on CBC
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ANSWER:
- PMN% >70 on CBC – ALL ANSWERS ARE CORRECT
- albumin <3.5 on chem 10 – ALL ANSWERS ARE CORRECT
- sodium <135 on chem 10 – ALL ANSWERS ARE CORRECT
- vacuoles on CBC – ALL ANSWERS ARE CORRECT
- Dohle bodies on CBC – ALL ANSWERS ARE CORRECT
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CASE CONCLUSION: grew G+ cocci in chains in 4/4 bottles at <24h
CASE LESSONS:
