chbare Posted October 30, 2011 Author Share Posted October 30, 2011 However, you have a febrile patient to treat. Link to comment Share on other sites More sharing options...
DFIB Posted October 30, 2011 Share Posted October 30, 2011 (edited) However, you have a febrile patient to treat. My brain got caught up in the playing paramedic scenario, the goat cheese gave be a brain cramp with the fever. I would add paracetamol 500 mg q 4-6 hours to the doxicicline. Edited October 30, 2011 by DFIB Link to comment Share on other sites More sharing options...
Kiwiology Posted October 30, 2011 Share Posted October 30, 2011 (edited) I'm still thinking LRTI Paracetamol 1500mg q4h and doxycycline 100mg bd Can I have some obs and how are those bloods DFIB ordered looking? has the Sherpa come back on his camel yet? Depending on how the numbers look he can probably go back to his shipping container and come back for another chest film and repeat exam tomorrow ... I think any serious underlying pathology would present itself a bit more than a bit of crackles and a temperature. Could be environmental lung disease, what exactly does this bloke do? Edited October 30, 2011 by kiwimedic Link to comment Share on other sites More sharing options...
DFIB Posted October 30, 2011 Share Posted October 30, 2011 I'm still thinking LRTI Paracetamol 1500mg q4h and doxycycline 100mg bd Can I have some obs and how are those bloods DFIB ordered looking? has the Sherpa come back on his camel yet? Depending on how the numbers look he can probably go back to his shipping container and come back for another chest film and repeat exam tomorrow ... I think any serious underlying pathology would present itself a bit more than a bit of crackles and a temperature. Could be environmental lung disease, what exactly does this bloke do? I looked up my doxicicline dose and am going to have to roll with you on the dosages as opposed to the ones I posted before. I pulled those from my ear, or some other orifice. I am thinking that our culprit here is a Rickettsia. The best part is that the treatment would be the same as you propose for LRTI. cbare - you are killing me with suspense. Link to comment Share on other sites More sharing options...
Kiwiology Posted October 30, 2011 Share Posted October 30, 2011 I am thinking that our culprit here is a Rickettsia. The best part is that the treatment would be the same as you propose for LRTI. How do you figure that one mate? Did that also come from an oriface? LOL Link to comment Share on other sites More sharing options...
txladymedic Posted October 30, 2011 Share Posted October 30, 2011 With the lung sounds and fever....I'd like to see a resp rate, an SPO2, & B/P. Dizzyness? Lt. headed? What OTC meds has he taken? Anything make it better or worse? How long has this been going on? How much water has he been drinking? Is he drinking more or less than usual, is he urinating more or less that usual? Nausea/vomiting/diarrhea/constipation? Sore throat, runny nose, ear pain and if so what do his ears look like? Do you have anyone else that has presented to the clinic with similar symptoms? Allergies to meds...or anything else? Does he smoke or drink? Has he recently quit smoking? History of seasonal allergies? Without knowing anything else and just taking his lung sounds and fever into consideration....have him increase his water intake, might even consider ORS, tylenol 500mg q4-6 hrs possibly consider alternating with motrin 400 mg q4-6hrs, consider an antibiotic...augmentin 750mg BID x 10 days, zpack per pack directions or doxycycline 100 mg BID x 10 days. Recheck in the AM or earlier if symptoms worsen. 1 Link to comment Share on other sites More sharing options...
DFIB Posted October 30, 2011 Share Posted October 30, 2011 (edited) Actually Afghanistan is the orifice I am hoping it came from and not one closer to home. Typhus is pretty common in the third world. Especially in rural areas in less than ideal living conditions. Head ache for several days, general malaise, mild respiratory symptoms along with the living conditions and geography just seems like the right conditions. There is a lot of unpasteurized milk over there as well (brucellosis). The febrile antibodies panel and CBC should clear the air. They should have it. It is not a very complicated test. Even third world labs should have it. The military should definitely have it on hand. If it turrns out to be brucelosis we would have to add an entire battery of antibiotics. Salmonnella will give similar symptoms to the indigenous people but an american would be a permanent fixture in the head so i am kinda ruling that one out but not all together. Edited October 30, 2011 by DFIB Link to comment Share on other sites More sharing options...
mobey Posted October 30, 2011 Share Posted October 30, 2011 Any enlarged lymph nodes? Blood in sputum? Excessive sweating? Night sweats? Up to date on innoculations? I have no idea what you guys are up against as far as disease over there, but I am sure TB is an issue. Link to comment Share on other sites More sharing options...
Kiwiology Posted October 30, 2011 Share Posted October 30, 2011 It's good to see you blokes wanting to dish out paracetamol (tylenol) but you have to give it at much higher dosages for it to be effective. 500mg is only one tablet (the recommended dosage is 2-4) and there is good evidence that 20mg/kg or 1500mg is very effective. Link to comment Share on other sites More sharing options...
mobey Posted October 30, 2011 Share Posted October 30, 2011 It's good to see you blokes wanting to dish out paracetamol (tylenol) but you have to give it at much higher dosages for it to be effective. 500mg is only one tablet (the recommended dosage is 2-4) and there is good evidence that 20mg/kg or 1500mg is very effective. Ya: 15mg/kg is where it is at for me Link to comment Share on other sites More sharing options...
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