Reference no: EM133875149

Question

You are called on a patient in the ED to admit a 35-year-old Caucasian male with a history of IV drug use who presented today with fever, chills, malaise, and shortness of breath. Differential Diagnoses: Based on the presentation of fever, chills, malaise, shortness of breath and IV drug use, list 5 differential diagnoses: 1. Bacterial Endocarditis 2. Pneumonia 3. Sepsis 4. Pulmonary Embolism 5. HIV/AIDS- related Opportunistic infections. HPI: This is a 35-year-old Caucasian male with a history of IV heroin use, presenting with 4 days of subjective fevers, chills, fatigue, and worsening dyspnea. The patient reports poor appetite and weight loss over the past month. He denies recent dental procedures but admits to using unsterile needles regularly. He also denies chest pain or hemoptysis. In the ER, he is noted to have tachycardia, hypotension, and a new systolic murmur, and you note track marks on both forearms. PMH: IV drug use (heroin, ongoing for 10 years) Recurrent cellulitis PSH: None SH: Smoker, 1 pack/day Homeless, living in shelters IV heroin use daily FH: Father died of a myocardial infarction at age 65. Mother is alive with Type 2 Diabetes. Allergies: No known drug allergies (NKDA). Home Medications: None What are 4 Pertinent Positives from the HPI 1. Fever and Chills 2. Worsening Dyspnea 3. New Systolic Murmur 4. Track Marks on Forearms Labs in the ED: WBC: 18,000/mm³ Hgb: 11.5 g/dL Platelets: 90,000/mm³ Sodium: 133 mEq/L Potassium: 4.8 mEq/L Creatinine: 1