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Toxicology Conference

Presented by F1 林立原 Instructed by Dr . 許景瑋 2011/11/11. Toxicology Conference. General Data. Age: 45-year-old Gender: male Ethnic: Taiwanese Marital status: single Occupation: worker. Chief Complaint. Burning clothes in room with drowsy conscious. Present Illness.

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Toxicology Conference

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  1. Presented by F1 林立原 Instructedby Dr.許景瑋 2011/11/11 Toxicology Conference

  2. General Data • Age: 45-year-old • Gender: male • Ethnic: Taiwanese • Marital status: single • Occupation: worker

  3. Chief Complaint • Burning clothes in room with drowsy conscious

  4. Present Illness • This 44-year-old male has unremarkable medical history except aloholism and alcoholic liver disease. He was sent to the ED because of burning clothes in room with drowsy conscious, which was noticed by his elder brother. • At ED, brain CT showed no intracranial hemorrhage. CO-Hb level was 23%, along with profound shock, leukocytosis and bandemia.

  5. Past History • No hypertension or diabetes mellitus • No operation history of major organs

  6. Personal History • No known allergy to food or drugs • Smoking: denied by his brother • Alcohol consumption: heavy drinker • Betel nuts chewing: denied by his brother

  7. Physical Examination • T 36℃ P: 125/min, R: 24/min, BP: mmHg • Height: 160cm, weight: 50kg, BMI:19.5 • Consciousness: E4V4M6 • HEENT: pink conjunctiva, no thyroid goiter • Chest: rapid and labored respiration, bilateral clear breathing sounds. • Heart: regular heart beats, no murmurs. • Abdomen: soft, flat, normal bowel sounds • Extremity: freely movable, no pitting edema. • Skin: ecchymoses over lips, knees and legs

  8. Laboratory Findings

  9. Laboratory Findings

  10. Laboratory Findings

  11. Laboratory Findings

  12. CXR

  13. Hospitalization course Cr: 2.87 (10/7) Cr: 0.46 (10/9) MBD 11/04 Musculoskeletal CT Ceftriaxone 10/07~10/12 Ceftazidime 10/12~11/03 10/21 Fasciotomy

  14. Impressions • Carbon monoxide intoxication • Septic shock, focus: left hand cellulitis and urinary tract infection; urine and wound culture: Pseudo. aeruginosa • Acute kidney injury, RIFLE-F, due to rhabdomyolysis • Macrocytic anemia, favor alcoholism related • Acute hepatitis, consider shock liver

  15. Discussion

  16. The end

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