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Mrs. Beacon, an 80-year-old female, is brought to the emergency room with recent onset of stupor. Her family reports that she has been complaining of fatigue and has been going downhill for some time with progressive withdrawal and somewhat paranoid behavior.

Diagnosis:
She was initially diagnosed with possible stroke because of lateralizing neurological signs. Later, hypothyroidism and early myxedema coma was diagnosed.

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Diagnosis: She was initially diagnosed with possible stroke because of lateralizing neurological signs.
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Presenting signs/symptoms:

Hyporeflexia on right side (could be from previous stroke), heart rate was 55, temperature 96°F, skin was dry, her hair was thinning and she had continued stupor. The ECG showed a sinus bradycardia and low voltage.

Relevant lab values (assume all other lab values are normal): Urinalysis revealed urinary tract infection, T3 and T4 normal, TSH elevated

Relevant diagnostic tests: Chest x-ray shows enlarged heart.

In your review of this case, please address the following questions. Please include at least 5 research articles and/or Web citations as references.

1. What are the etiology and risk factors associated with this case?

2. What is the pathophysiological basis for the signs/symptoms that are seen in this case?

 

 

Mr. Smith is a 16 year old male. He was hit on the left upper leg in a slide tackle while he was playing high school boys and girls soccer championship game.

 

He arrived at the emergency room in stable condition. He had lacerations on his face and c/o pain in his right upper leg. T 98, P 86, R 20, BP 138/88.

 

Laboratory Values

Hb 14.5 gm/dl, Hct 42%; Chemistries-WNL

 

Diagnostic Test

Chest x-ray- normal; fracture of the right femur. ECG- normal sinus rhyme.

His fracture site is stabilized and he is sent to the surgical unit. The next day, he becomes confused, disoriented, and dyspnic, and has tachycardia and a temperature of 100 F. Within an hour, he becomes diaphoretic and cyanotic. Blood gases are: pH 7.25, pCO2 56, HCO3 24, pO2 58.

Mr. Smith is suspected of having a fat embolism and he is intubated and placed on mechanical ventilation: tidal volume (TV) 1000 ml, intermittent mandatory ventilation (IMV) 6/min, positive end-expiratory pressure (PEEP) 5 cm H20, and FIO2 50%. An hour later, his pH is 7.54, pCO2 30, HCO3 25, pO2 94.5.

In your review of this case, please address the following questions. Please include at least 5 research articles and /or Web citations as references.

 

1. What do his ABGs indicate?

 

2. What is the pathophysiological basis for the signs/symptoms that are seen in this case?

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