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CPC CASE

CPC CASE. Dr. Sara K. Ornazian D.O. Core Faculty McLaren Oakland Pontiac, MI. Welcome to Vegas!. What do we know. 73 year old female Altered, abdominal pain, sepsis alert VSS

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CPC CASE

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  1. CPC CASE Dr. Sara K. Ornazian D.O. Core Faculty McLaren Oakland Pontiac, MI

  2. Welcome to Vegas!

  3. What do we know • 73 year old female • Altered, abdominal pain, sepsis alert • VSS • Discomfort, dry mucus membranes, coarse breath sounds, increased bowel sounds with guarding and rebound, heme positive and disoriented

  4. Differential Diagnosis • Sepsis • Encephalopathy • GI Bleed • Liver Failure Stroke Thyroid disease Toxicological syndrome

  5. Purse vs. Satchel

  6. Empty our satchel.. • WBC 15.7 • INR 2.2, PT 24.7, PTT 31 • K+ 2.5 • AG 7 • AST/ALT normal • Troponin negative • UA- blood, ketones, protein • EKG- sinus tachycardia • Medications

  7. New differential • Sepsis- where is the source?? • Encephalopathy • GI Bleed • Chronic Salicylate Toxicity • Stroke • DIC

  8. Seizure……Why??

  9. Images • Chest X-ray – Intubated, No acute process • CT Head – No acute process • CT Abdomen/pelvis – diverticulosis, thinning of the renal cortex - ATN

  10. Top 3 differential • 1.) Sepsis • 2.) GI Bleed • 3.) Chronic Salicylate Toxicity

  11. What I wish I had.. • A more detailed neurological exam • TSH and Free T4 • Salicylate level, Acetaminophen level, ABG • MRI

  12. Final Diagnosis • Chronic Salicylate Toxicity

  13. Thank You

  14. References • Leatherman J, Schmitz P. Fever, Hyperdynamic Shock, and Multiple System Organ Failure. A Pseudo- Sepsis Syndrome Associated with Chronic Salicylate Intoxication. Chest. 1991 Nov; 100(5) 1391-1396. • Yip L, Compiler. Tintinalli’sEmergency Medicine: selected bibliography. New York (NY) McGraw Hill; c2011. Chapter 183, Aspirin and Salicylates. 1243-1246.

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