Academic Fellow/Clinical Instructor, Division of Emergency Medicine
|This post was peer reviewed.|
Click to learn more.
Case: The patient is a 91 y/o female with hypertension, hypothyroidism, and Alzhiemer’s dementia brought in by ambulance from home for fever to 102 F and vomiting. There are no other complaints or symptoms per the caregiver and the patient. In the ED, the patient is alert and oriented to self only (at baseline she is oriented to location as well). Vital signs are as follows: T 102.4 F (oral), HR 120, BP 130/80, RR 20, SpO2 91% RA (95% on 4L nasal cannula). Her exam is otherwise notable for dry mucus membranes, decreased breath sounds at the left lung base, soft and non-tender abdomen, and no rash. Initial studies are notable for an EKG showing sinus tachycardia without signs of ischemia and a lactate of 6.14. Chest x-ray showed an opacity in the left lower lobe, and urinalysis showed evidence of infection.