Round 5 (Geriatric Fall)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!



Case Introduction



The nurse is asking you to evaluate a 70 year old male who has been placed in a hall bed after hitting the back of his head. She wants to know if you would like to call a trauma alert…



Initial Vitals



* Temp 103.7 (Hidden by Examiner)* HR 115* RR 18* BP 110/75* O2 99%



Critical Actions



* Diagnose Fournier’s Gangrene on Secondary Survey* Obtain Full Vital Signs Including Temperature* Perform Sepsis “Core Measures”* Initiate Appropriate Treatment for Fournier Gangrene* Immediate Surgical Consultation



Final Diagnosis



Septic Shock due to Fournier Gangrene



Tips and Tricks



Always ask for the patient’s temperature if it is not given with initial vital signs



Additional Reading



* Fournier Gangrene Overview (PubMed)* Basic Approach to Sepsis (EM Clerkship)* Basic Approach to Trauma (EM Clerkship)