Severe Symptoms, but a Truly Treatable Disease

​BY NOURA MAHDI; DARRON LEWIS; JEREMY OSBORNE; & AHMED RAZIUDDIN, MDA 73-year-old man was brought to the emergency department from his nursing home for rectal bleeding and anemia. The patient mentioned he had had episodes of bright red rectal bleeding and constipation for a few months. A colonoscopy had been done prior to the visit, which revealed a large intestine tumor and biopsy confirming adenocarcinoma. He was awaiting an appointment with his surgeon.The patient reported bloody rectal leakage, and a CBC done at the nursing home showed a hemoglobin level of 7.2. He also complained of dyspnea but denied any other symptoms. He was alert and oriented to person, place, and time with no abnormal findings on physical exam aside from gross blood during the rectal examination. His past medical history was significant only for hyperlipidemia treated with simvastatin.His vitals were taken twice in the ED, and he had mild tachycardia that improved before admission. (See Figure 1.) The most important findings from his blood work was a RBC count of 2.11 m/ul and a hemoglobin of 5.5 g/dL. A transfusion of two units of packed red blood cells was ordered, which he received on the floor.Figure 1. The patient's vital signs at ED and hospital admission.The patient's labs were drawn again the next day, and his hemoglobin improved to 8.0 g/dL post-transfusion. A blood culture showed growth of Escherichia coli, revealing the patient's septic status apart from his rectal bleeding. He...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research