1 / 17

Bryan S Judge, MD IUSOM Medical Toxicology Fellowship ACMT CPC Competition September 5, 2003

The Shit That Killed A Rock Star. Bryan S Judge, MD IUSOM Medical Toxicology Fellowship ACMT CPC Competition September 5, 2003. Case Presentation. 25 year-old male Chief complaint: Dyspnea Diagnosed with Pneumocystis carinii pneumonia at another ED

marly
Télécharger la présentation

Bryan S Judge, MD IUSOM Medical Toxicology Fellowship ACMT CPC Competition September 5, 2003

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Shit That Killed A Rock Star Bryan S Judge, MD IUSOM Medical Toxicology Fellowship ACMT CPC Competition September 5, 2003

  2. Case Presentation • 25 year-old male • Chief complaint: Dyspnea • Diagnosed with Pneumocystis carinii pneumonia at another ED • Patient transferred to a tertiary referral hospital

  3. Past Medical History • Illicit drug abuse with several prior admissions to drug rehabilitation centers • Negative HIV antibody test within the last year • Denies regular use of any prescription or OTC medications • Has no known drug allergies

  4. Social History • History of intravenous cocaine, heroin and methamphetamine abuse • Unemployed, lives with girlfriend • Smokes 1 pack of cigarettes/day • Denies use of ethanol • Occasional marijuana use

  5. Case Presentation • Patient remained dyspneic upon arrival to the tertiary referral hospital • Patient denied use of cocaine, heroin, or methamphetamine for several days

  6. Case Presentation • He admitted to taking 2 carisoprodol tablets within the last 24 hours • Patient denied any cough, fever, chills, chest pain, recent weight loss, or sharing of needles

  7. Case Presentation • “Yeah, the shit that killed [rock star]. I knew it had to be a good trip if it killed [rock star]!”

  8. Pertinent Physical Exam Findings • Vitals: T- 98.3°F RR- 30/min P- 105/min BP- 112/72 mmHg O2 Sat- 82% on room air O2 Sat- 91% on 100% NRB • General: Well nourished and in mild respiratory distress

  9. Pertinent Physical Exam Findings • Heart: Tachycardic without murmur or rub • Lungs: Diffuse rales bilaterally • Extremities: Track marks in the left antecubital fossa and multiple tattoos on chest and arms • Remainder of exam is unremarkable

  10. Complete Blood Count 15.8 15.9 240 45.0 60% Neutrophils 26% Lymphocytes 6% Monocytes

  11. Chemistry Panel 138 12 105 141 4.6 23 0.7 Anion gap = 10

  12. Other Studies • Calcium: 8.6 mg/dL • Arterial Blood Gas on Room Air: • pH: 7.40 • pCO2: 34 mmHg • pO2: 46 mmHg • HCO3-: 23 mEq/L

  13. Other Studies • ECG: • Sinus tachycardia • QRS – 88 msec • QTc – 390 msec • No ectopy and no ischemic changes • Salicylate, APAP and Ethanol Levels: • All are nondetectable

  14. Other Studies • Urine Drug Screen: • Amphetamines – Negative • Cocaine – Negative • THC – Positive • Benzodiazepines – Negative • Barbiturates – Negative • Tricyclic Antidepressants – Negative • Opiates – Negative

  15. Making The Diagnosis • Further history provided by the patient helped to elicit the etiology behind his clinical condition

More Related