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    Grandrounds Protocol Servando

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    Allison Eunice Servando
    This document summarizes a case presentation at Iloilo Doctors Hospital's Internal Medicine Grand Rounds Conference on March 21, 2023. A 78-year-old male was admitted for generalized body weakness secondary to urosepsis from a complicated urinary tract infection caused by E. coli. He experienced worsening symptoms over several days such as chills, difficulty breathing, and urinary issues. On admission, he was pale and in respiratory distress. Tests found abnormal white blood cell count and imaging showed pneumonia. The presentation discussed diagnosing and managing complicated UTIs to identify potential complications early.

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    Grandrounds Protocol Servando

    Uploaded by

    Allison Eunice Servando
    19 views4 pages
    This document summarizes a case presentation at Iloilo Doctors Hospital's Internal Medicine Grand Rounds Conference on March 21, 2023. A 78-year-old male was admitted for generalized body weakness secondary to urosepsis from a complicated urinary tract infection caused by E. coli. He experienced worsening symptoms over several days such as chills, difficulty breathing, and urinary issues. On admission, he was pale and in respiratory distress. Tests found abnormal white blood cell count and imaging showed pneumonia. The presentation discussed diagnosing and managing complicated UTIs to identify potential complications early.

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    This document summarizes a case presentation at Iloilo Doctors Hospital's Internal Medicine Grand Rounds Conference on March 21, 2023. A 78-year-old male was admitted for generalized body weakness secondary to urosepsis from a complicated urinary tract infection caused by E. coli. He experienced worsening symptoms over several days such as chills, difficulty breathing, and urinary issues. On admission, he was pale and in respiratory distress. Tests found abnormal white blood cell count and imaging showed pneumonia. The presentation discussed diagnosing and managing complicated UTIs to identify potential complications early.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    19 views4 pages

    Grandrounds Protocol Servando

    Uploaded by

    Allison Eunice Servando
    This document summarizes a case presentation at Iloilo Doctors Hospital's Internal Medicine Grand Rounds Conference on March 21, 2023. A 78-year-old male was admitted for generalized body weakness secondary to urosepsis from a complicated urinary tract infection caused by E. coli. He experienced worsening symptoms over several days such as chills, difficulty breathing, and urinary issues. On admission, he was pale and in respiratory distress. Tests found abnormal white blood cell count and imaging showed pneumonia. The presentation discussed diagnosing and managing complicated UTIs to identify potential complications early.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    Iloilo Doctors Hospital Inc.

    Department of Internal Medicine – Grand Rounds Conference


    March 21, 2023 | 8:00am | IDH Conference Room/Zoom
    meeting

    Case: Urosepsis Secondary to Complicated unrecalled antibiotics taken twice a day.


    Urinary Tract Infection (E.coli) Episodes of chills and difficulty of breathing
    Case Presenter: Dr. Allison Eunice B. Servando persisted, now accompanied by dribbling of
    Moderator: Dr. Myrianne Jade B. Vasig urine. no fever and dysuria noted.

    General Objectives
    1 Day prior to Admission:
    To discuss the case of a 78/M who came in due
    to generalized body weakness Patient experienced hypo gastric pain that
    radiates to the epigastric area, pressing in
    Specific Objectives character with a pain scale of 6/10. he was
    • To discuss how to approach patient with unable to pass flatus and stool. chills, occasional
    Complicated Urinary Tract Infection. difficulty of breathing, and dribbling persisted.
    • To discuss the Pathophysiology and the
    Symptomatology of UTI On The Day of Admission:
    • To discuss the Differential Diagnosis and
    complications of UTI. Above signs and symptoms persisted which was
    • To discuss the Treatment and now accompanied with bloatedness.
    Management of UTI. hypogastric pain radiating to the epigastric area
    increased in intensity rated as 9/10, associated
    General Data with generalized weakness. patient decided to
    • EMJ seek consult. thus, this admission.
    • 78/M
    • Married Past medical History
    • Roman Catholic (+) HCVD
    • Molo, Iloilo City
    (+) Diabetes mellitus
    • Admitted last February 23, 2023
    (+) Bronchial asthma (last attack
    2020)
    Chief Complaint
    Generalized Body Weakness. (+) COVID infection (2019)
    (-) Previous hospitalizations
    History of Present Illness
    Family History
    3 days prior to Admission:
    (+) Hypertension and Diabetes both sides of the
    The patient's wife noticed him to be pale- family
    looking. this was associated with chills and (+) Malignancies (lung cancer) on maternal side
    difficulty of breathing. patient self-medicated (-) Bronchial Asthma
    with paracetamol 500 mg which offered
    temporary relief, but due to persistence of Personal History
    symptoms, patient decided to seek consult at • Previously smokes but quitted since 1968
    idh-opd. labs were requested but due to influx (0.7 pack years)
    of patients in the triage, patient opted to go • Occasional alcoholic beverage drinker
    home. no nausea, vomiting, fever or dysuria with preference to beer
    noted. • Businessman who owns a machine shop
    • Lives with his wife and his only daughter
    2 Days Prior to Admission:
    Laboratories results came back which revealed
    urinary tract infection. He was prescribed with
    Iloilo Doctors Hospital Inc.
    Department of Internal Medicine – Grand Rounds Conference
    March 21, 2023 | 8:00am | IDH Conference Room/Zoom
    • Usual diet: Vegetables, pork broth, fish meeting
    and fruits • tachypneic
    • No history of illicit drug use, risky • Palpation: No palpable masses, equal
    sexual behavior, tactile fremitus
    • Percussion: No dullness
    Physical Examination • Auscultation: Bibasal fine crackles
    Patient was seen wheel chair borne, awake,
    conversant, coherent, pale looking and in GASTROINTESTINAL:
    cardiopulmonary distress • Inspection: flabby abdomen, no striae, no
    visible veins, no surgical scars, no
    Vital signs bruises/hematomas
    Temperature: 36.8⁰C
    • Auscultation: Normoactive bowel sounds
    Pulse rate: 89 bpm
    on all quadrants, no abdominal bruits
    Respiratory rate: 26 cpm
    • Percussion: Tympanitic on all quadrants,
    Blood pressure: 90/60 mmHg
    Height: 163cm liver span 7 cm midclavicular line and 5
    Weight: 68kgs cm midsternal line, (-) CVA tenderness
    BMI: 25.6 kg/m2; overweight • Palpation: Soft, nontender, (-) Murphy’s
    sign, (-) organomegaly
    SKIN
    • Inspection: No lesions GENITOURINARY:
    • Palpation: Warm to touch, no palpable • Inspection: no discharges, superficial
    masses, capillary refill time >2secs scars, vesicles on the genital area.
    • Palpation: Non distended bladder, no
    HEENT lumps, masses and tenderness on
    • Inspection: Normocephalic, pale hypogastric
    conjunctiva, anicteric sclerae, non
    inflamed and nonhyperemic tonsils, dry Digital Rectal Exam: Skin tag, no external
    lips, moist buccal mucosa hemorrhoids and fistulas noted. Admits finger
    • Palpation: No palpable masses on the with ease, good sphincter tone, no masses or
    scalp and neck, no jugular vein prostatomegaly, no blood on examining finger
    distention, no cervical
    lymphadenopathies MUSCULOSKELETAL
    • Auscultation: No carotid bruits • INSPECTION: No swelling, masses noted;
    pale nail beds, no clubbing;
    CARDIOVASCULAR: • PALPATION: No peripheral edema with
    • Inspection: Adynamic precordium grade 2 peripheral pulses
    • Palpation: PMI at 5th ICS no point
    tenderness Chest Xray AP view
    • Auscultation: regular rate and rhythm, Pulmonary congestive changes
    no murmurs. Intercurrent Pneumonia Bilateral
    RESPIRATORY: Elevated Right hemi diaphragm
    • Inspection: Symmetrical chest Thoracic Hypertrophic degenerative
    expansion, no chest wall deformity, osteoarthritic changes
    •
    Iloilo Doctors Hospital Inc.
    Department of Internal Medicine – Grand Rounds Conference
    March 21, 2023 | 8:00am | IDH Conference Room/Zoom
    meeting

    CBC Results Reference

    Hemoglobin 130 135-180


    Hematocrit 0.37 0.40-0.54
    RBC 4.26 4.2-6.0

    WBC 22.63 4.5-11.00


    Segmenters 0.89 0.50-0.70
    Lymphocytes 0.02 0.22-0.40
    Eosinophils 0.01 0.01-0.04
    Monocytes 0.08 0.03-0.08
    Iloilo Doctors Hospital Inc.
    Department of Internal Medicine – Grand Rounds Conference
    March 21, 2023 | 8:00am | IDH Conference Room/Zoom
    meeting

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