57 year old female with history of recurrent urinary tract infections, hypertension, type II diabetes, depression presents to the emergency department with dizziness and weakness.
Starting two days ago she began having dysuria. She has a history of multiple UTIs and this felt similar. She called her primary care doctor who prescribed levofloxacin however her symptoms continued. Six hours prior to arrival in the ED, she began feeling weak and light headed. She checked her temperature and it was 102, and her husband brought her to the emergency department.
T 101.6 HR 120 BP 100/76 RR 22 SPO2 99% on room air
General: in mild distress, appears uncomfortable, very thin
CVD: tachycardic, 2/6 systolic murmur
LUNGS: distant breath sounds but some crackles present at bases
ABDOMEN: soft, nontender
EXTREMITIES: no edema or deformity
Cr 1.3 (baseline 1.0)
Urinalysis: SG 1.01 small blood, TNTC white blood cells, + leukocyte esterase, + nitrates
EKG: sinus tachycardia
CXR: no infiltrates; mild pulmonary edema
Cardiac parasternal long
Cardiac apical 4 chamber view
Lung anterior and posterior
Lung R base
IVC longitudinal view
The patient received 2 liters of normal saline on arrival and the ED nurse is hanging another bag now. You are called by the ER physician to admit this patient.