Timmy Posted October 18, 2008 Share Posted October 18, 2008 You’re on duty at a small hospital in a rural town when a 40 year old male dairy farmer presents to Emergency complaining of generally feeling unwell. The patients has a clean bill of health, no substantial history, no previous hospital admission, some general practitioner visits for the usual (coughs, colds, aches and pains) over the past few years and is very hesitant about receiving treatment. His reasons for presenting is he feels as though his “been hit by a truck” and this is unusual for him because his “never had any medical problems in his life” He then went on to assure us that his sure he’ll be fine but wants a quick “once over”. The wife is also present and is concerned, they have the little kids with them as they live out of town, its 2315 and you need to make the assessment quick, write a prescription for him and he’ll go pick it up after milking tomorrow morning. The patient states he exhibited flu like symptoms (sore throat, very minor cough and myalgias) this lasted for 2 days. Patient is asymptomatic for 4 days then presents to emergency today feeling extremely fatigued. On assessment vitals are all within normal limits apart from being febrile, when you conduct a Nero exam you find some jaundice in both eyes. ** I know it’s not an EMS call but it turns out to be very interesting all the same** Link to comment Share on other sites More sharing options...
rdelisle Posted October 18, 2008 Share Posted October 18, 2008 What's his temp and does he have a rash? Might be anthrax. Link to comment Share on other sites More sharing options...
Chief1C Posted October 18, 2008 Share Posted October 18, 2008 Abd. tenderness? EBV Test? Recent injuries? Open or septic wounds? Decreased urine output? [spoil:c77daadeb4]Marburg, Leptospirosis or Hep A?[/spoil:c77daadeb4] Link to comment Share on other sites More sharing options...
Timmy Posted October 18, 2008 Author Share Posted October 18, 2008 Temp is 39.8 C You notice a rash on his stomach when you go in for the abdo assessment. Abdo - Increased pain on palpation right hypocondriatc region. Nill recent injury Nill wounds And he states there decreased urine output. Your out in the sticks, little rural hospital... wana call the doc? Link to comment Share on other sites More sharing options...
firedoc5 Posted October 18, 2008 Share Posted October 18, 2008 Color of urine? Any neck pain? Any outstanding bug bites recently? Any minor/moderate scrapes or scratches lately that he might not have even noticed? Any unusual vision problems? Even though fatigued, how is his sleeping habits? Last Tetnus shot? ETOH habits? Call doc. IV NS TKO. (don't want to over load this guy if urine output is diminished.) Link to comment Share on other sites More sharing options...
Timmy Posted October 19, 2008 Author Share Posted October 19, 2008 Colour of urine is unknown. His had general myalgias so he has had pain from head to toe. A good physical examination reveals nothing apart from the rash on abdo. Nill vision problems. Sleeping habits have been normal. Bed @ 2200 Awake @ 0400. Last tetnus shot was years ago, unknown. His fully alert, telling you there is nothing wrong with him. You notice on your 15mins vitals his pulse and BP are ever so slowly decreasing, again still within normal limits. You’ve called the doctor and his 30mins away NACI running. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 19, 2008 Share Posted October 19, 2008 he's got some obscure aussie disease that's gonna kill him. Link to comment Share on other sites More sharing options...
Timmy Posted October 19, 2008 Author Share Posted October 19, 2008 No, no lol! It’s not a common problem but it can happen anywhere. It’s literally in front of your eyes. While you’re waiting for the doctor the rash appears to be getting worse. The nursing staff consult and decided the rash appears hemorrhagic. The Grade 5 nurse immediately nurse initiates ceftriaxone IMI to be on the safe side. The doctor arrives, you immediately inform him of the abdominal pain, rash and medication administration. The doctor then has a good poke around and gives him a good physical examination. After consult with the nursing staff we come to the conclusion he has hepatomegaly. Link to comment Share on other sites More sharing options...
Chief1C Posted October 19, 2008 Share Posted October 19, 2008 Hepatomegaly is the dx? Unless I'm pronouncing it wrong, I've never heard the word before. Link to comment Share on other sites More sharing options...
firedoc5 Posted October 19, 2008 Share Posted October 19, 2008 A buddy of mine works a dairy farm north of us. I'll have to run that by him. I just don't know if his biulb is bright enough. But come to think of it, my bulb is a bit dim on this one. It does sound familiar, such as a blood poisoning. Possible from ingesting unpasturized milk? I'm so ashamed of myself. :crybaby: And I don't mean Anthrax Link to comment Share on other sites More sharing options...
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