2021-08-12-morning-report.md (1213B)
1 # nausea, vomiting, fever, and a fall 2 3 67F with T2DM (well-controlled w/o insulin), hypoTh, asthma, presented after 3d n/v, with lightheadedness, weakness, low-grade fever, and a fall. 4 5 Denies hitting head. 6 7 At baseline previously. 8 9 100.3F at home. No sick contacts. Non-productive cough, also x3d. 10 11 No new meds. No known inciting events. 12 13 Woke up and called a friend (not found down). 14 15 OSH - hypotensive, given zosyn and 2L LR 16 17 # SHx 18 - 2-4 beers/day 19 20 # PMHx 21 - T2DM 22 - asthma 23 - depression 24 - osteoporosis 25 26 # Meds 27 - metformin 28 - synthroid 29 - lexapro 30 - inhalers 31 - fosamax 32 33 # VS 34 Hypotensive, tachypnea 35 On pressors 36 37 # PE 38 tachycardic, tachypneic, fairly warm, AOxSelf, still following commands 39 40 41 # Data 42 - WBC 2.4, Hgb 10.7, Plt 28 43 - COVID -ve 44 - Bicarb 12, Cr 1.7 45 - Bili 2.8, D bili 2.3 46 - ALK/AST/ALT elevated 47 - 7.3/33 48 - LA 4.5 49 50 # ... went to huddle, missed a bunch... 51 52 53 # Dx 54 55 Ehrlichiosis! Tx w doxy. 56 57 Time to diagnosis is delayed in pts who require ICU admission (Kuriakose 2020, JAMA Network Open, e202577) 58 59 # Pearls 60 61 For RMSF, no need to send w/u unless clear geographic exposure. 62 63 Send Ehrlichia/anaplasmosis PCR, smear, consider babesia. 64 65 Lyme: should have travelled north of the Mason-Dixon line, not endemic to TN.