July 2016 Critical Care Case of the Month

Saturday, July 2, 2016 at 8:00AM
Rick Robbins, M.D. in atelectasis, endobronchial lesion, gastric ulcer, heat stroke, hyperthermia, mucormycosis, multisystem organ failure, pneumoectomy, silver stain, treatment

Warren Carll, DO

Susanna Tan, MD

Shannon Skinner, MD

 

Maricopa Integrated Health System

Phoenix, AZ USA

 

Critical Care Case of the Month CME Information

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive 0.25 AMA PRA Category 1 Credits™ for each case they complete. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity. 

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours 

Lead Author(s): Warren Carll, DO.  All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity.

Learning Objectives:
As a result of this activity I will be better able to:

1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None

 

History of Present Illness

The patient is a 20-year-old man with admitted to Maricopa Integrated Health System unconscious after being found down on a hiking trail.

Past Medical History

Hypertension and morbid obesity.

Physical Examination

• Vital signs: BP 90/60 mm Hg, P 128 beats/min, Respiration 28 breaths/min, T 105.8º F, SpO2 98% on 2 L/min by NC.
• General: he is unresponsive to verbal stimuli but withdraws from pain
• Neck: there is no jugular venous distention. Thyroid is not palpable.
• Lungs: clear
• Heart: Regular tachycardia without murmur
• Abdomen: Obese but soft without organomegaly or tendernesses
• Extremities: apparent burns over both lower extremities

Which of the following should be done initially? (Click on the correct answer to proceed to the second of five panels)

1. Cool the patient as quickly as possible
2. Cool the patient slowly to prevent cerebral edema
3. Aggressively administer normal saline to correct hypotension
4. 1 and 3
5. All of the above

Cite as: Carll W, Tan S, Skinner S. July 2016 critical care case of the month. Southwest J Pulm Crit Care. 2016;13(1):9-14. doi: http://dx.doi.org/10.13175/swjpcc046-16 PDF 

Article originally appeared on Southwest Journal of Pulmonary, Critical Care and Sleep (https://www.swjpcc.com/).