Here's an interesting case for you all to digest. The patient's history was central to his treatment and disposition but was difficult to obtain (mom wasn't forthcoming with details for some reason). Digest and enjoy. I'm interested to see what some of you would do for this patient before reading the spoilers.
18YO African American male with a history of T4 paraplegia (I'm unsure of mechanism, but chronic).
Per family, he's been "sick" for a couple of days. He had a decub on his sacrum debrided a few weeks ago, now it kinda smells and he feels dizzy, so they decided to come in.
HR 139
BP 74/28
RR 24
O2 56%
N: Arousable but minimally interactive
CV: No murmur, no edema
P: Tachypneic with increased work of breathing,
MSK: Cacechtic 2/2 paraplegia, severe clubbing of his fingernails
The feeling around the room was that this pt was septic and needed to be intubated and bundled immediately. But Mom was super chill, very unconcerned about his hypoxemia...
Stand by for more details.... can't get spoiler tags to work