Covert
Multisystem Processes & Disorders
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M40_F1.jpg"}},{"insert":"\n\n"},{"insert":"For a hot summer night, it\u0027s been an unusual evening in the ER.\r\n \r\nMixed in with the usual cases of sunburn, dehydration and cuts and fractures, you\u0027ve identified a diphtheria case and DVT. You\u0027ve saved two lives so far, and feel exhilarated.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M40_F2.jpg"}},{"insert":"\n\n"},{"insert":"One of the triage nurses approaches you, shaking her head.\r\n \r\n\u0022Here you go, doctor. Another patient just came in. He\u0027s unconscious with no immediately identifiable cause.\u0022\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M40_F3.jpg"}},{"insert":"\n\n"},{"insert":"Nick Michaelson is a 25-year-old male with no significant medical history, presenting with unconsciousness and extreme pallor. He is not alert or responsive.\r\n \r\nHe was brought in by ambulance and his parents followed.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M40_F4.jpg"}},{"insert":"\n\n"},{"insert":"You ask to speak with Nick\u0027s family. His mother approaches you, clearly distraught.\r\n \r\nShe tells you that her son has always been in good health and with a seemingly happy life. He used to go out regularly with his friends.\r\n \r\nLike typical young men, they enjoyed the nightlife and frequented the local clubs.\n\nHowever, she sheds some light on Nick\u0027s recent behavior. She states that Nick has been acting in an atypical manner; distant and very guarded about his friends and social life.\r\n \r\nShe hesitates to wipe her eyes. \u0022I received a phone call today and the next thing I know is that \u2026 well, here we are \u2026\u0022\n"}]}
4
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M40_F5.jpg"}},{"insert":"\n\n"},{"insert":"You proceed with the physical exam.\r\n \r\nYou notice that Nick has bradypnea, bilateral miosis, and very cold skin, with a blood pressure of 110\/60 mmHg and a mild oxygen desaturation of 91%.\r\n \r\nThe tidal volume is markedly decreased, and he has a 38.5\u02daC fever.\n"}]}
5
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M40_F6.jpg"}},{"insert":"\n\n"},{"insert":"Upon examining Nick\u0027s body, you notice several bruises, and maculopapular rashes over the medial aspect of both forearms. His GCS score is 3\/15.\r\n \r\nHis lungs are clear, but you note mild tricuspid regurgitation. A rapid blood glucose test shows him to be normoglycemic.\n"}]}
6
{"ops":[{"insert":"What is the next step in your management?\n"}]}
1. Oxygen and a trial dose of naloxone
2. Oxygen and intravenous (IV) vancomycin
3. Oxygen and IV ceftriaxone
12
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8
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9
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7
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10
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11
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