Topic: Infectious Disease Diagnosis Read the following case and answer the questions using EBP. AJ is a 44-year-old male who presents to ED with sudden onset of shaking-chills, fever, and a productive cough. He reports that he was in his usual state of health until one week ago when he developed mild nasal congestion and achiness.
Otherwise, he felt well until last night when he became feverish and developed a cough associated with right-sided pleuritic chest pain. He says he is not in pain unless he coughs and has headaches, throat soreness, and voice changes. He reports thick yellow sputum occasionally with no odor. He denies chest pressure, radiating pain, SOB, DOE, and orthopnea. He denies N/V/D and unintentional weight loss.
He does not recall being around anyone with the flu or other illnesses and has not had any travel outside the U.S. in the past year. He has no past medical history but admits he does not go to the doctor regularly, admits to smoking ½ pk per day of cigarettes, no drug use, and occasional alcohol. He is married with 2 children and works as a lineman. He takes no medications and no OTC supplements but does take ibuprofen for occasional aches and pains.
Physical Exam Remarkable for the following: BP: 118/72 HR: 113 Respirations: 20 Temp: 102.1 SPo2: 99% RA WT: 185 Ht: 72” Lungs: Bronchial Breath sounds and End-inspiratory Crackles in RLL CV: RRR, no murmurs, rubs, or gallops Diagnostic & Lab Results Chest Xray shows an RLL consolidation CBC: WBC 7.4, RBC 5.2, Hemoglobin 15.3, Hematocrit 44.0, Plt 302 BMP: sodium 138, potassium 4.2, bicarbonate 25, BUN 20, creatinine 1.0, glucose 122
Update: While AJ was awaiting discharge home on PO medication, he started having increased SOB and now appears mildly diaphoretic. New labs are pending.
- What are your top 3 differential diagnoses and your final diagnosis?
- Based on updated information, how will you treat AJ? (Give any newly created tests ordered, results, and/or findings).
- What is the most likely pathogen?
- Empiric Therapy: What will you use? (Think about your hospital antibiogram when prescribing)
- What would you change if AJ was allergic to PCN?
- How will you alter the dosing if AJ develops ARF?
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