Infective endocarditis

Abstract

Although the paramedics administer a dose of I.V. naloxone, JM' s clinical status doesn't improve. Upon arrival at the ED, his vital signs are core body temperature, 102.4° F (39.1° C); heart rate, 114; respiratory rate, 26; SpO 2 96% on supplemental oxygen at 4 L/minute via nasal cannula; and BP, 84/49. Two large-bore peripheral I.V. catheters are inserted and 2 L of 0.9% sodium chloride solution is administered I.V. bolus. An additional dose of naloxone doesn't improve his clinical status. Blood and urine specimens are obtained and sent to the lab, including specimens for lactate level, two sets of blood cultures, and urine culture and sensitivity.About 25 minutes after JM' s arrival to the ED, his BP hasn't increased significantly despite the fluid challenge. His SpO 2 has dropped to 81% on supplemental oxygen at 15 L/ minute via non-rebreather mask, and he' s dyspneic. A stat portable chest X-ray shows bilateral pulmonary edema. Due to his increased work of breathing and hypoxemia, he' s endotracheally intubated and placed on mechanical ventilation. A diuretic can't be safely administered because of his hypotension. Diagnostic testingSee Close up on abnormal lab values for JM' s abnormal blood work results. A urinalysis displays no evidence of infection. A 12-lead ECG shows sinus tachycardia with no significant abnormalities. A broad-spectrum antibiotic is initiated, and he' s admitted to the medical ICU for suspected sepsis.That evening, JM' s parents arrive at the hospital and inform the staff that their son has an ongoing heroin addiction. The nurse relays this information to the healthcare provider and a stat bedside transthoracic echocardiogram (TTE) is ordered. The echocardiogram shows severe left ventricular dysfunction with a left ventricular ejection

Dermatological Changes in Patient With Infective Endocarditis

“…Embolic strokes; septic pulmonary emboli; septic arthritis; and muscular, renal, and splenic infarctions have all been noted in the IE patient with cutaneous lesions. Embolic events because of the inflammatory cascade of the disease process are the primary cause of the cutaneous lesions (Degheim et al, 2020; Josephson, 2014), Osler nodes, purpura, macula hemorrhages including cotton wool spots, splinter hemorrhages, and conjunctival hemorrhages are all examples of this embolic phenomenon (Degheim et al, 2020; Fareedy et al, 2016; Laing, 2015).…”

“…Roth spots, hemorrhagic lesions on the retina, can occur because of septic emboli. The lesions are red with a pale or white center and can be noted upon examination of the eye (Laing, 2015). The dermatological changes including Osler nodes, Janeway lesions, splinter hemorrhages, and conjunctival hemorrhages seen on the patient within this case study were key in the quick diagnosis of IE.…”

“…To promptly diagnose and manage infective endocarditis (IE), it is imperative that a thorough skin assessment is performed (Degheim et al, 2020; Laing, 2015). Because of the high morbidity and mortality rates associated with IE, early recognition and management of the disease is vital in improving prognosis and preventing complications.…”