Multisystem Processes & Disorders


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M20_F1.jpg"}},{"insert":"\n\n"},{"insert":"It\u0027s a bright, warm Sunday.\r\n \r\nYou\u0027re in the process of choosing between a jog in the park and a relaxed stroll down the street for some ice cream, before heading to the ER for your night shift ....\r\n \r\n... only to be interrupted by the sudden ringing of your phone.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M20_F2.jpg"}},{"insert":"\n\n"},{"insert":"\u0022I need your help!\u0022 says Jane, an old friend, sounding breathless and panicked. \u0022My son, Tierre, has run away.\u0022\r\n\r\nYou recall that Tierre, now 20 years old, was diagnosed with schizophrenia around four years ago.\r\n \r\nDespite proper medical care, and a supportive family enviroment, he has experienced no less than three relapses since the time of diagnosis.\n"}]}


{"ops":[{"insert":"Jane\u0027s family had recently moved to the city and Tierre seemed to be having a hard time adjusting to his new life.\r\n \r\nJane tells you that he has been looking especially upset these last few days. Yesterday, he barely ate, saying that he was unable to swallow.\n\nThis morning the parents noticed him muttering incoherently, although he has been taking his antipsychotic medication quite regularly.\r\n \r\nJane and her husband Mark realized from experience that he may be hallucinating, but before they could calm him down or seek help, he became agitated and ran out the front door screaming \u0022They\u0027re out to get me!\u0022\n"}]}


{"ops":[{"insert":"\u0022Let\u0027s split up and search along the routes familiar to him,\u0022 you suggest helpfully. Your conversation is interrupted as Jane receives a call on her other line.\r\n \r\nMark answers. It\u0027s the local police.\n\nThe police found Tierre sitting on a nearby street corner, holding his head and looking terrified.\r\n \r\nThankfully, they quickly figured that he may require medical attention and managed to reassure him and bring him to the nearby hospital, where you work.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M20_F5.jpg"}},{"insert":"\n\n"},{"insert":"You tell Jane you\u0027ll meet them at the hospital and quickly hang up the phone, grab your keys and leave. \r\n\r\nYou arrive at the ER to find Tierre looking weak but alert and quite agitated. You request his parents to wait outside, and gently ask him what\u0027s wrong.\n\n\u0022I don\u0027t feel well at all. They\u0027re out to get me,\u0022 he says, somewhat effortfully. \r\n \r\nYou reassure him, saying that you can help, and request to examine him, to which he agrees.\n\nHis temperature is 39\u02daC (102.2\u02daF), with a pulse of 130 beats per minute, a blood pressure of 80\/50 mmHg, and respirations of 32 cycles per minute.\r\n \r\nYou notice that he is barefoot with small shards of glass sticking out from several cuts on his sole.\n\nHe is perspiring despite the air conditioning of the ER; he speaks through a clenched jaw with an unemotive countenance, although he is evidently agitated and overly alert to his surroundings.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M20_F6.jpg"}},{"insert":"\n\n"},{"insert":"You request for his wounds to be cleaned and dressed and begin fluid replacement with a crystalloid infusion, administering acetaminophen (paracetamol) for his fever.\r\n \r\nAs a catheter is inserted to monitor his output, you notice a dark red discoloration of the outflowing urine. Blood and urine samples are sent to the lab for analysis.\n\nMark looks uneasy. \u0022He still seems quite agitated doctor, and he hasn\u0027t been sleeping well these last couple of days. Can we give him haloperidol or something to get him to sleep?\u0022\n"}]}