Case follow up
Coincident with our presumption, Methicillin Resistant Staphylococcus Aureus grew up in sternoclavicular synovial fluid. Vancomycin was started as soon as possible.
Regarding the patient's dyspnea and hypoxia, chest CT scan was done which showed bilateral nodules and round masses and bilateral multilobar pleural based lesions.

Urine analysis:
SG 1025
WBC 0-1
RBC many
Bacteria few
Ep cell 1-2
Protein 3+
Nitrite negative

Transthoracic echocardiogram showed no significant vegetation or other abnormalities. Blood culture was also positive for Methicillin Resistant Staphylococcus Aureus. The picture shows the patient's nail.

Case number 30
A 21 y/o female came to the emergency ward with dyspnea, pruritis, fecal incontinence and lips bulging.
She mentioned penicillin intramuscular injection in a clinic 10 minutes before her attendance.
On physical examination, she was alert and conscious but toxic. Generalized urticarial plaques and erythema were seen on the skin. Bilateral wheezing was detected on lung auscultation, and mild abdominal tenderness was present on periumbilical examination.
BP 80/30 mmHg
PR 110/min
RR 26/min
SPO2 85% room air
T 37°C

Acute management of anaphylaxis (Up-to-date)

I hope you find this case and podcast useful.
If you are interested in this case presentation method, share the channel and podcast with your friends.

Participate in answering questions and share your comments and feedback with us.

Best for you,
ARMH

End of case 30

Case number 31
A 44-year-old construction worker comes to the emergency department due to nausea and fatigue over the past 2 days.  The patient strained his back at work 7 days ago.  He was unable to move for several days and has been taking over-the-counter pain medications and applying hot packs.  The patient still has significant back pain and limited mobility.  He smokes 1 pack of cigarettes a day.  The patient drinks alcohol daily and heavily on weekends.  In addition, he uses intravenous heroin on occasion.

He was hospitalized for pneumonia 6 months ago and treated with intravenous antibiotics.  Echocardiogram during that admission showed normal left ventricular systolic function, a mildly dilated right ventricle, and mild pulmonary hypertension.

Temperature is 37.2 C (99 F), blood pressure is 94/50 mm Hg, and pulse is 112/min.  There is mild scleral icterus.  Several needle tracks are seen on both forearms.  No heart murmurs are present.  The lungs are clear.  There is no abdominal distension.  Moderate right upper quadrant tenderness is present.  The spleen is not palpable.  There is no peripheral edema.

Laboratory results are as follows:

Serum chemistry
Sodium 148 mEq/L
Potassium 3.2 mEq/L
Chloride 106 mEq/L
Bicarbonate 22 mEq/L
Blood urea nitrogen 27 mg/dL
Creatinine 1.7 mg/dL
Liver function studies
Albumin 3.8 g/dL
Bilirubin
Total 3.2 mg/dL
Direct 2.2 mg/dL
Alkaline phosphatase 190 U/L
Aspartate aminotransferase (SGOT) 3578 U/L
Alanine aminotransferase (SGPT) 4235 U/L
Coagulation studies
International Normalized Ratio (INR) 1.7