🚀 go-pugleaf

This is the sixth post from me and lab work results are included. but
first:

>Would try to determine if the patient had and episode of chest paint,, and
>in the already mentioned labs I would include serum ketones, and lactic
>acid level. (these may have already been ordered I may have missed them) 
see below
>And I would if not already done determine try orientation.  There is
>changes noted in his attention span so I would investigate this. Not sure
>if this has been established, but would assess the abdomen better, maybe
>since he has not taken his coat off yet,it has not been established the
>size (fluid) of his abdomen which could be causing a lot of his complaints,
>and if their is any bowel sound (obstruction????)  Also, chech his
>peripheral pulses.  May need to do a CT, head and abdomen if no finding
>seem to come up from lab work.

Orientation is fair to good- he knows who he is, where he is, and what
month it is. He continues to be easily distractable, occasionally
making off the wall comments over your shoulder.

The patient is stripped and bathed (That's the order I was looking
for: "Bath, STAT!")- multiple bruises and scabs are noted along the
arms, legs and back. Liver is still noted to be under the costal
margin, and there is little fluid wave. Bowel sounds are quiet.

it is now 1200 hrs, tues am.

Lab work:

CBC: 15,700 WBC with 80 neut, 10 band, 5 lymph, 5 eos, hgb 9.4, hct
28, mcv 108

SMAC panel : Ca 8.0, Mg 2.0, P 3.4, Glucose 110, BUN 50, Creatinine
3.0, Uric Acid 11.0, Triglycerides 230, Cholesterol 90, T bili 3.0, D
bili 2.0, T protein 7.0, Albumin 2.5, Alk Phos 200, LDH 500, AST/SGOT
450, ALT/SGPT 500, CPK 1000, Na 115, K 3.0, CO2 15, Cl 100, 

CK-MB fractionate= 50 (5%)

Lactate levels are pending

Blood alcohol 0.15%

Ketone small positive

EKG already posted.

CXR: bilateral lobar infiltrates worse on right side with cavitating
lesion seen in the right base.

repeat ABG on O2 after hydration: pH 7.35, CO2 40, O2 65, sat 89%

Breathing is noted to be somewhat more labored.

What do you want to do now?

Charles S. Krin, DO FAAFP KC5EVN, Member, PGBFH
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