Introduction
Respiratory distress was the main reason for why patient John Doe (J.D.) was presented in the ER. As soon as the patient was observed by the doctor for the first time, an IM injection of epinephrine and an inhalation machine with albuterol were given to the patient. It was necessary to continue observations and investigations such as the chest X-ray, blood tests to provide a proper diagnosis and identify the causes of distress. During a certain period of time, it was concluded that the patient had sepsis that is a defined as a clinical syndrome (Schmidt and Mandel par.1). It is usually characterized by systemic inflammation due to infection and a severe development that can result in a septic shock (Schmidt and Mandel par.1). This laboratory report aims at discussing the peculiarities of the diagnosed disease management and the ways of how sepsis can be developed in the patient’s organism using the results of X-rays and blood tests.
Results
The patient’s hospitalization was characterized by a number of interventions and an overnight observation. One of the first steps in addition to the injection of epinephrine and an inhalation machine was a chest X-rays. The results of this test proved lung inflammation (Fig. 1). It was a cloudy white spot on the patient’s x-ray image. Besides, a portion of blood tests was taken to identify the reasons for the patient’s distress (Table 1: Results from Initial Laboratory Tests). The increased number of white blood cells (17.3) proved the fact that there is an infection in an organism. Other reasons for such WBC number may be the stress or inflammation. Therefore, it is necessary to consider other aspects of the blood test. For example, the levels of hemoglobin, platelets, creatinine, glucose, urea, GGT, ALP, and bilirubin were normal. Some changes were observed in ALT (alanine transaminase). This test measures the amount of the required enzyme in the patient’s blood. The results were twice higher than normal and indicated the elevated liver enzymes that were observed in patients with bacterial sepsis (Shah et al. 261). Finally, slight changes were observed in the international normalized ratio (INR) that indicated the correctness and appropriateness of the chosen blood-thinning medication warfarin.
A high amount of INR identifies the necessity of more time for the blood to clot and the possibility of sudden bleeding without a possibility to stop it. In general, the results of the blood tests helped to identify the infection in the body, and it was necessary to continue investigations to clarify if sepsis is the reason for respiratory distress. A lung biopsy helped to clarify the situation. An abnormal condition close to the surface of the lung proved the possibility of bacterial lung infection. The patient’s H&E stain, CD4+ stain, and B220 stain were marked in the lung biopsy. Unfortunately, the condition of the patient worsened in a short period of time. Fever was the reason for why the patient had a positive result for microbial products and the increased amount of IL-10 and IFN-Y (Fig. 3). With time, the Multiple Organ Dysfunction score showed the abnormal results in almost all organ systems. Besides, the chemical and blood gases composition turned out to be abnormal as well (Table 2: Multiple Organ Dysfunction). Such results usually indicate the complete organ dysfunction or even death. Despite all treatment and doctors’ interventions to increase fluids and antibiotics, it was impossible to stop the blood pressure falling. The patient did not manage to recover and passed away soon after his immediate hospitalization.
Discussion
In fact, the results of the blood tests and X-rays should help to understand the possibility of sepsis on the initial stages of the hospitalization process. The point is that sepsis may be of different levels, and it becomes harder to control in case one stage is missed. As a rule, difficulties in breathing and respiratory distress are not the initial stages of the disease. It means that the patient was already closed to a septic shock when he was hospitalized. Eggimann et al. explain that sepsis remains to be one of the most crucial causes of morbidity and mortality among the hospitalized patients, and the rates can be changed if the patients have acute respiratory distress syndrome at the same time (1210). The worth of the blood tests is all about the possibility to identify if the organism has an infection or undergoes some inflammation process. It helps to identify the main following steps and manage the disease treatment in the required way. At the same time, a white spot on the X-rays image informs about the problems with lungs and the necessity to continue diagnosing the patient with the help of the lung biopsy. The results of the biopsy and the fibrotic tissues that could be observed in the H&E stain could be identified as the main possible causes of the respiratory distress that bothered the patient at the beginning of the hospitalization process. Fever and the inabilities to reduce the pain during breathing were the additional symptoms that proved a fast sepsis development in the organism.
Conclusion
In general, the evaluation of the case study and the test results help to comprehend that sepsis is hard to predict and treat. Despite all tests and interventions, it was hard to help the patient and decrease the level of pain experienced. The situation under analysis proved that sepsis could be developed gradually; still, if it was identified at the late stages, it was hard and even impossible even for sufficient doctors to treat a patient and save their life.
Works Cited
Eggimann, Philippe, Stephan Harbarth, Bara Ricou, Stephane Hugonnet, Karin Ferriere, Peter Suter, and Didier Pittet. “Acute Respiratory Distress Syndrome after Bacteremic Sepsis Does not Increase Mortality.” American Journal of Respiratory and Critical Care Medicine 167.9 (2003): 1210-1214.
Schmidt, Gregory, A. and Jess Mandel. “Evaluation and management of severe sepsis and septic shock in adults.” Uptodate.com 2013. Web.
Shah, Amir, A., Michael Patton, Wajahat H. Chishty, and Amir Hussain. “Analysis of Elevated Liver Enzymes in an Acute Medical Setting: Jaundice May Indicate Increased Survival in Elderly Patients with Bacterial Sepsis.” The Saudi Journal or Gastroenterology 16.4 (2010): 260-263.