This patient had been in a prior accident and was being treated for an ankle wound. I was chart checking the medics and saw he had fevers for 6 days despite being on antibiotics (Cloxacillin is their gram positive med and they had him on IV Metronidazole too). He would be a Sepsis Alert in a bigger hospital. Yesterday was my second clinical day this week and he had been admitted last Friday after I left. I saw all medical patients 2 days ago and then saw all the trauma patients yesterday, along with the sicker medical patients again. So I went to examine him for the first time, already intending to tweak his antibiotics with some I bought from India. His ankle was warm and tender but not swollen or oozy. He said it felt a lot better but his ipsilateral thigh was hurting a lot. I noted a warm, swollen, and tender thigh. He had a healed surgical scar there. I grabbed the ultrasound and discovered a big fluid collection all along the top 2/3 of his femur. One portion was encapsulated. S
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Got potassium?
Today we had a young lady with Type I diabetes who presented with blood glucose in the 300s, diffuse weakness or and 3 ketones in her urine. She also had diffuse abdominal tenderness but no distention or guarding or bleeding anywhere. Vitals rather stable. She had been off of her diabetes medication for a few months. She actually had received care at the local Thai hospital in the past and had been an oral medication only. There was some concern for DKA. Interestingly, the head medic pulled out their guidelines for chronic disease, and I peered over her shoulder while I worked on a quality measures project I’m doing. The DKA guidelines said to give 1 liter IVF per hour. That is all. Their only clue to potential acidosis was ketones in the urine. They can’t test metabolic panel, pH; don’t have insulin drip or potassium infusions. We have subQ insulin leftover from patients who have expired, and a bottle of insulin I bought at the local pharmacy just in case. We have potassium tabl