Feverish
Immune System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M29_F1.jpg"}},{"insert":"\n\n"},{"insert":"It\u0027s 6 a.m. and you\u0027re watching the sunrise through the large ER waiting room window, just before your shift is due to begin. \r\n \r\nThe internist you take over from looks tousled from a heavy night-shift, although presently, there seems to be a lull in admissions.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M29_F2.jpg"}},{"insert":"\n\n"},{"insert":"As if on cue, an evidently unwell young man comes through the automated sliding doors. \r\n \r\nMr. Pine is 34 years old. \u0022I\u0027ve had this fever for two weeks now,\u0022 he begins, tiredly. \u0022Haven\u0027t had much of an appetite either, and I feel weak all the time, like my body has no strength.\u0022\r\n \r\nHe denies having any major illnesses, or the use of alcohol, tobacco, or illicit substances.\n\nYou request to examine him. His BP is 90\/54 mmHg, with a heart rate of 110 bpm, and a temperature of 38.5\u00baC.\r\n \r\nHis lung fields are clear on auscultation, but you pick up on a grade II\/VI systolic cardiac murmur.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M29_F3.jpg"}},{"insert":"\n\n"},{"insert":"You find a small, infected puncture wound on his right index finger.\r\n \r\n\u0022Got pricked by a nail while assembling a swing set for my son,\u0022 he explains, noticing you examining the wound keenly. \r\n \r\nAll his vaccines are up to date, including his tetanus shot which he got four years ago.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M29_F4.jpg"}},{"insert":"\n\n"},{"insert":"Now that the initial assessment is over, you ponder what to do next.\n"}]}
4
{"ops":[{"insert":"What do you do now?\n"}]}
1. Order a gurney, two IV lines, and oral acetaminophen. Administer 1000cc of saline over 15 minutes
2. Administer 1000cc IV saline, as he seems dehydrated, and give him acetaminophen. Discharge him with a prescription for antibiotics, and reassess in a week
7
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6
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5
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