Triage: BIBA for abnormal labs with WBC 19.2, AOX2, baseline per RN is normally AOX3, 103.5F, Dysuria X 3 days
History of Present Illness: 60-ish-year-old female with a history of CAD s/p CABG x 3 and stent, chronic systolic CHF, hypertension, hyperlipidemia, presence of AICD, left ventricular aneurysm, severe PAD with multiple revascularizations, diabetic foot ulcers, history of osteomyelitis/MRSA, DM on insulin, peripheral neuropathy, CKD stage III, prior CVA, seizures and chronic anemia presents with 3 days of fevers chills, left upper quadrant abdominal pain that radiates to the back and dysuria. Patient denies nausea, vomiting, diarrhea, shortness of breath, chest pain.
Vital Signs: T: 38.2 °C (Oral) HR: 89 RR: 15 BP: 124/47 SpO2: 98%
Physical Exam: Tender LLQ and L CVA
Initial Diagnostic Testing:
- CBC and CRP: WBC 16
- Chem-7 and UA:
- 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
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QUIZ ANSWER:
- A) Pyelonephritis
- B) Gastritis
- C) Diverticulitis
- D) None of the above – CORRECT: She has emphysematous cystitis
SCROLL DOWN FOR ANSWERS
1-Minute Consult on this topic: Click HERE and scroll to page 176.
CASE CONCLUSION: urology consulted and recommended Foley drainage; admitted to ICU and started on broad spectrum antibiotics
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