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icumicuccu
Re: 54 yr old with hyperpyrexia and respiratory failure
This patient was in good health and collapsed after being in sun all day.
All his cultures (blood, urine, CSF) were negative. He was treated with emperic rocephin (ceftriaxone)
This patient has heatsroke and ARDS (acute respiratory distress syndrome)
rhabdo is more common in exertional as apposed to classic form 25% of these patient progress to renal failure
another 25% with severe heatsroke develop ARDS
this patient had exertional heatsroke complicated by hepatic injury. pulmonary edema rhabdo and come. His Crdiac index was 5.5 and PAOP (pulmonary artery occlusion pressure of 10.
despite rapid cooling from partial ice immersion he progressed to DIC and renal failure and died 10 days latter never regaining consiousness
in the last 3 mon there are new intravenous thermal catheters now to rapidly make core temperature changes they are inserted throught the femoral route
yasir
Re: 54 yr old with hyperpyrexia and respiratory failure
This patient is having septic shock with high anion gap metabolic acidosis (?lactic acidosis), raised CPK and Potasium, reflecting increased muscle breakdown. Diffuse respiratory rales can be explained by Aspiration penuomonia / ARDS. Does patient has any history of seizures? Have you done his CSF examination for Meningococemia / Encephalitis? What is the urinlysis report? Is it positive for Myoglobinuria? (Rhabomyolysis?)
icumicuccu
54 yr old with hyperpyrexia and respiratory failure
Here is case that is relevent to your practice.
54 yr man admitted to ICU after collapsing at a picnic this month. He was in good health but began to talk strangely with friends after a full day outside in the sun. He collapsed suddenly. Paramedics found him cyanotic and hypotensive with tachycardia. On exam his temp was 41 degrees, pulse 120, BP 90/40. He was unconcious, intubated and had diffuse rales. heart exam was normal.
Labs showed a WBC of 14, HCT 43, Na 148, K 5.6, CPK 9000, ABG on 100% on ventilator Ph 7.31, PCO2 31, PO2 58., On chemistries his HCO3 was 15, BUN32 and Cr 1.2.
What is the cause of this pateitns collapse and respiratory failure?
