Back to Base Day Case 1: 23 female, 2 days unwell (flu like, headache, vomiting). 1 day of sore throat, rash mild itchy that started in leg then spread. Nil chest pain, meningism, back pain, bowel changes, resp or neuro sx. Nil else. Allergy to penicillin. Meds: OCP. Ddx Viral illnesses e.g. influenza, EBV Meningococcal meningitis, meningococcemia Ex HR 140, RR 18, BP low, appears unwell. Non blanching macular rash. RUQ tenderness. Red tonsils but not enlarged Ddx: Viral hepatitis Sepsis Ix: neuts increased with left shift = bacterial infection? Others suggestive of metabolic acidosis and AKI, ALT increased, mild coagulatopathy, CRP 370, bHCG <1 Ddx Gram negative sepsis Acute meningococcemia Meningitis Pneumonia Viral EBV Turns out to be toxic shock - genital s/s Interesting points
Case 1: 23 female, 2 days unwell (flu like, headache, vomiting).
1 day of sore throat, rash mild itchy that started in leg then
spread. Nil chest pain, meningism, back pain, bowel changes, resp
or neuro sx. Nil else. Allergy to penicillin. Meds: OCP.
DdxViral illnesses e.g. influenza, EBVMeningococcal meningitis,
meningococcemia
ExHR 140, RR 18, BP low, appears unwell. Non blanching macular
rash. RUQ tenderness. Red tonsils but not enlarged
Ddx:Viral hepatitisSepsis
Ix: neuts increased with left shift = bacterial infection?
Others suggestive of metabolic acidosis and AKI, ALT increased,
mild coagulatopathy, CRP 370, bHCG tdsBest APTT ranges 5000LMWH -
anti factor Xa levelsEnoxaparin 40mg daily prophylaxisChange if
obese, >30% if BMI>4040mg bd if BMI50Caution in renal
failureOff label in pregnancyNOACs - who shouldnt be on themActive
significant bleedingDisorder of haemostasisProsthetic heart
valvesPoor renal functionKnown sensitivityInteracting
medicationPregnant/breastfeedingLiver disease childpugh B or
CStably anticoagulated on warfarin
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