vimwiki

commit 7b8b7ba18b71260634715b3ea02f4cb345dd7b8f
parent 27be78f2c935458628f26683d440a17c150c1849
Author: Beau Hilton <beau.hilton@vumc.org>
Date:   Thu, 12 Aug 2021 11:52:19 -0500

morning report

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learn/2021-08-12-morning-report.md
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+# nausea, vomiting, fever, and a fall
+
+67F with T2DM (well-controlled w/o insulin), hypoTh, asthma, presented after 3d n/v, with lightheadedness, weakness, low-grade fever, and a fall.
+Denies hitting head.
+
+At baseline previously.
+
+100.3F at home. No sick contacts. Non-productive cough, also x3d.
+
+No new meds. No known inciting events.
+
+Woke up and called a friend (not found down).
+
+OSH - hypotensive, given zosyn and 2L LR
+
+# SHx
+- 2-4 beers/day
+
+# PMHx
+- T2DM
+- asthma
+- depression
+- osteoporosis
+
+# Meds
+- metformin
+- synthroid
+- lexapro
+- inhalers
+- fosamax
+
+# VS
+Hypotensive, tachypnea
+On pressors
+
+# PE
+tachycardic, tachypneic, fairly warm, AOxSelf, still following commands
+
+
+# Data
+WBC 2.4, Hgb 10.7, Plt 28
+COVID -ve
+Bicarb 12, Cr 1.7
+Bili 2.8, D bili 2.3
+ALK/AST/ALT elevated
+7.3/33
+LA 4.5
+
+# ... went to huddle, missed a bunch...
+
+
+# Dx:
+
+Ehrlichiosis! Tx w doxy.
+
+Time to diagnosis is delayed in pts who require ICU admission (Kuriakose 2020, JAMA Network Open, e202577)
+
+# Pearls
+For RMSF, no need to send w/u unless clear geographic exposure.
+Send Ehrlichia/anaplasmosis PCR, smear, consider babesia.
+Lyme: should have travelled north of the Mason-Dixon line, not endemic to TN.