Cluster
Busters

The Case of Dr. Wanda B. Better

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Page Content:  Marti Lindsey

Medical Records

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(Check the boxes when you are done recording the information)

Patient A (11 Years Ago)
 
Name:
  Withheld
Address:
  1700 City Blvd
Doctor:
  Knowzit
Age:
  12 weeks
Sex:
  Female
Previous Conditions:
  None
Symptoms:
  Child not breathing upon arrival to hospital, resuscitation attempts made by paramedics
Tests Conducted:
  Autopsy ordered
Diagnosis:
  pulmonary hemorrhaging
  Sudden Infant Death Syndrome (SIDS)
Treatment:
  Endotracheal intubation, manual and shock resuscitation attempts
Allergies:
  Unknown
Outcome:
  Death

 

Patient B (7 Years Ago)
Name:
  Withheld
Address:
  5900 Somewhere Ave
Doctor:
  Helpu
Age:
  4 weeks
Sex:
  Male
Previous Conditions:
  None
Symptoms:
  Prior to Hospital Admission - vomited once, fussy, rapid breathing, grunting
Upon Admission - cyanotic, pale, grunting, nasal flaring, intercostal retractions, blood entered tube upon intubation
Tests Conducted:
 
  10.1 g/dl
  29.3%
  4.5 million/ mm3
  15,400/mm3
  457,000/ mm3
  17.7 sec
Sickle Cell Screen:
  negative
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Unknown; possible environmental exposure
Treatment:
  Oxygen, medications given atropine, midazolam, and succinylcholine endotracheal intubation, Vitamin K
Allergies:
  None
Outcome:
  Discharged


Patient C ( 3 Years Ago)

Name:
  Withheld
Address:
  2102 Out There Lane, Someplace Else, OH 22134
Doctor:
  Cureall
Age:
  3 yrs
Sex:
  Female
Previous Conditions:
  Admitted 3 times previously for pulmonary hemorrhaging
Symptoms:
  Anemia; pulmonary infiltrates; fever
Tests Conducted:
 
Chest Radiograph:
  pulmonary infiltrates present
  5.9 g/dL
Lung biopsy:
   
  High
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Unknown (possibly immune-mediated)
Treatment:
  Prednisone; immunosuppressant azathioprine
Allergies:   Codeine
Outcome
  Discharged with 1 month nurse check-up


Patient D (2 Years Ago)
Name:
  Withheld
Address:
  4233 E. 33rd Ave. Apt. 202
Doctor:
  Better
Age:
  8 weeks
Sex:
  Male
Previous Conditions:
  None
Symptoms:
  Pale, respiratory failure, blood in intubation tube
Tests Conducted:
 
  19.2 thousand/mm3
  6.5 g/dL
  24%
  16.1 seconds
  301 thousand/ mm3
Bacterial cultures:
  negative
Viral cultures:
  negative
  negative
Chest radiograph:
  bilateral alveolar densities, no pleural effusions or pneumothorax
Sickle Cell Screen:
  negative
  2% of the macrophages contain iron indicating hemosiderosis
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Unknown; Possible Environmental Exposure
Treatment:
  Oxygen, steroids, respiratory support, Vitamin K
Allergies:
  None
Outcome:
  Discharged. Readmitted 3 days later. outcome: Death.


Patient E (2 Years Ago)
Name:
  Withheld
Address:
  5100 E. 25th Ave. Apt. 2
Doctor:
  Cureall
Age:
  4 weeks
Sex:
  Male
Previous Conditions:
  None
Symptoms:
  Prior to hospital admission - vomiting, fussy, rapid breathing, grunting
Upon Admission - pale, cyanotic, nasal flaring,
Tests Conducted:
 
  10.3 thousand/mm3
Hemoglobin:   10.1 g/dL
Hematocrit:   29.3 %
Prothrombin Time:   12.1 seconds
Platelet Count:   457,000 / mm3
Bacterial cultures:   negative
Viral cultures:   negative
Milk specific IgE:   negative
Chest radiograph:   bilateral alveolar densities, no pleural effusions or pneumothorax
Sickle Cell Screen:
  negative
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Unknown
Treatment:
  Inserted endotracheal tube, suctioned bright red blood from tube multiple
times
Allergies:
  None
Outcome:
  Discharged


Patient F (2 Years Ago)
Name:
  Withheld
Address:
  1500 Ohio Rd.
Doctor:
  Better
Age:
  24 weeks
Sex:
  Male
Previous Conditions:
  None
Symptoms:
  Pre-admission - limpness, grunting
Post-admission - lethargy, grunting, respiratory failure
Tests Conducted:
 
Hemoglobin:   7.8 g/dL
Hematocrit   22%
Red Blood Cells:   2.7 million/ mm3
Red Blood Cell Hemolysis:   positive
White Blood Cells:   30 thousand/ mm3
Prothrombin Time:   12.0 seconds
Serum Magnesium:   2.9 mg/dL
Milk IgE:   positive
Glucose-6-phosphate dehydrogenase screen:   negative
Diagnosis:
  Pulmonary Hemorrhage
  Milk IgE positive
Treatment:
  Antihistamines, respiratory support
Allergies:
  Milk
Outcome:
  Discharged


Patient G (2 Years Ago)
Name:
  Withheld
Address:
  3016 Midwest Blvd. #A10
Doctor:
  Better
Age:
  5 weeks
Sex:
  Male
Previous Conditions:
  None
Symptoms:
  Pre-admission - crying, limpness, color change
Post-admission - grunting, lethargy, respiratory failure, acute hemoptysis
Tests Conducted:
 
Hemoglobin:   7.2 g/dL
Hematocrit:   23.6%
Red Blood Cells:   4.5 million/ mm3
Red Blood Cell Hemolysis:   positive
White Blood Cell:   18.7 thousand/ mm3
Prothrombin Time:   12.7 seconds
Serum Magnesium:   1.9 mg/dL
Milk IgE:   negative
Glucose-6-phosphate dehydrogenase screen:   negative
Sickle Cell Screen:   negative
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Unknown; Possible Environmental Exposure
Treatment:
  Respiratory support
Allergies:
  None
Outcome:
  Discharged


Patient H (1 Year Ago)
Name:
  Withheld
Address:
  4233 E. 33rd Ave. Apt. 210
Doctor:
  Cureall
Age:
  10 weeks
Sex:
  Male
Previous Conditions:
  Water intoxication
Symptoms:
  Pre-admission - crying, limpness, pallor
Post-admission - grunting, lethargy, respiratory failure, acute hemoptysis
Tests Conducted:
 
Hemoglobin:   10.6 g/dL
Hematocrit:   19.2%
Red Blood Cells:   3.2 million/ mm3
Red Blood Cell Hemolysis:   positive
White Blood Cell:   15.6 thousand/ mm3
Prothrombin Time:   15.1 seconds
Serum Magnesium:   2.3 mg/dL
Milk IgE:   negative
Glucose-6-phosphate dehydrogenase screen:   negative
Sickle Cell Screen:   negative
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Unknown
Treatment:
  Respiratory support
Allergies:
  None
Outcome:
  Discharged. Readmitted 2 weeks later. Discharged


Patient I (1 Year Ago)
Name:
  Withheld
Address:
  5404 E. 33rd Ave.
Doctor:
  Healthman
Age:
  12 weeks
Sex:
  Male
Previous Conditions:
  Febrile seizure due to bacterial infection at 4 weeks of age
Symptoms:
  Pre-admission - difficulty breathing, pale
Post-admission - lethargy, respiratory failure
Tests Conducted:
 
Hemoglobin:   7.2 g/dL
Hematocrit:   28.0%
Red Blood Cells:   3.8 million/ mm3
Red Blood Cell Hemolysis:   positive
White Blood Cell:   10.9 thousand/ mm3
Prothrombin Time:   14.2 seconds
Serum Magnesium:   1.9 mg/dL
Milk IgE:   negative
Glucose-6-phosphate dehydrogenase screen:   negative
Sickle Cell Screen:   negative
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Unknown (smoking in household?)
Treatment:
  Steroids, respiratory support
Allergies:
  None
Outcome:
  Discharged. Readmitted 5 days later. Discharged.


Patient J (1 Year Ago)

Name:
  Withheld
Address:
  5400 E. 33rd Ave.
Doctor:
  Better
Age:
  6 weeks
Sex:
  Male
Previous Conditions:
  Hypernatremic dehydration
Symptoms:
  Pre-admission - crying, limpness, color change
Post-admission - grunting, lethargy, respiratory failure, acute hemoptysis
Tests Conducted:
 
Hemoglobin:   6.4 g/dL
Hematocrit:   18.8%
Red Blood Cells:   2.1 million/mm3
Red Blood Cell Hemolysis:   positive
White Blood Cell:   20.0 thousand/ mm3
Prothrombin Time:   13.0 seconds
Serum Magnesium:   3.0 mg/dL
Milk IgE:   negative
Glucose-6-phosphate dehydrogenase screen:   normal
Sickle Cell Screen:   negative
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Possible Environmental Exposure
Treatment:
  Ventilator support, resuscitation
Allergies:
  None
Outcome:
  Discharged


Patient K (1 Year Ago)
Name:
  Withheld
Address:
  5100 E. 25th Ave. Apt. 52
Doctor:
  Better
Age:
  6 weeks
Sex:
  Male
Previous Conditions:
  None
Symptoms:
  Pre-admission - abrupt cessation of crying, limpness, color change, pallor
Post-admission - grunting, lethargy, acute hemoptysis
Tests Conducted:
 
Hemoglobin:   7.9 g/dL
Hematocrit:   19.1%
Red Blood Cells:   4.5 million/ mm3
Red Blood Cell Hemolysis:   positive
White Blood Cell:   9.6 thousand/ mm3
Prothrombin Time:   16.8 seconds
Serum Magnesium:   2.1 mg/dL
Milk IgE:   negative
Glucose-6-phosphate dehydrogenase screen:   negative
Sickle Cell Screen:   negative
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Unknown; Possible Environmental Exposure
Treatment:
  Vitamin K, close observation
Allergies:
  None
Outcome:
  Discharged


Patient L (1 Year Ago)
Name:
  Withheld
Address:
  5503 E. 25th Ave. Apt. E3
Doctor:
  Cureall
Age:
  8 weeks
Sex:
  Female
Previous Conditions:
  None
Symptoms:
  Pre-admission - limpness, color change
Post-admission - lethargy, respiratory failure, acute hemoptysis
Tests Conducted:
 
Hemoglobin:   8.0 g/dL
Hematocrit:   22.4%
Red Blood Cells:   3.1 million/ mm3
Red Blood Cell Hemolysis:   positive
White Blood Cell:   8.4 thousand/ mm3
Prothrombin Time:   12.2 seconds
Serum Magnesium:   2.7 mg/dL
Milk IgE:   negative
Glucose-6-phosphate dehydrogenase screen:   negative
Sickle Cell Screen:   negative
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Unknown
Treatment:
  Respiratory support
Allergies:
  None
Outcome:
  Discharged


Patient M (1 Year Ago)
Name:
  Withheld
Address:
  5000 Quick Ave
Doctor:
  Better
Age:
  6 years
Sex:
  Female
Previous Conditions:
  Recurring strep throat
Symptoms:
  Pre-admission - fever, sore throat for ~ 6 days prior to admission, was treated with oral cephalosporins & antipyretics elsewhere fever subsided 1 day after start of medication patient stopped taking the drug, 3 days later redeveloped fever & sore throat.
Post-admission - cyanosis, dyspnea, blood in oral cavity & trachea
Tests Conducted:
 
Red Blood Cells:   3.0 million/ mm3
White Blood Cell:   29.8 thousand/ mm3
Immunoglobulin:   elevated
Bacterial cultures:   positive for Group A streptococci
Severe lysis of erythrocytes                         
Diagnosis:
  Lung hemorrhage
  Group A streptococci infection
Treatment:
  Antibiotics, ventilator support
Allergies:
  None
Outcome:
  Death.


Patient N (1 Year Ago)
Name:
  Withheld
Address:
  3006 Midwest Blvd. #42
Doctor:
  Healthman
Age:
  9 weeks
Sex:
  Male
Previous Conditions:
  None
Symptoms:
  Pre-admission - crying, limpness, color change
Post-admission - grunting, lethargy, respiratory failure, acute hemoptysis
Tests Conducted:
 
Hemoglobin:   10.2 g/dL
Hematocrit:   29.9%
Red Blood Cells:   3.3 million/ mm3
Red Blood Cell Hemolysis:   positive
White Blood Cell:   13.4 thousand/ mm3
Prothrombin Time:   12.2 seconds
Serum Magnesium:   2.1 mg/dL
Milk IgE:   negative
Glucose-6-phosphate dehydrogenase screen:   negative
Sickle Cell Screen:   negative
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Unknown (possible exposure to toxin - cocaine? Other?)
Treatment:
  Respiratory support, steroids
Allergies:
  None
Outcome:
  Discharged


Patient O (1 Year Ago)
Name:
  Withheld
Address:
  4800 Industrial Ave, Apt. 21
Doctor:
  Cureall
Age:
  15 weeks
Sex:
  Female
Previous Conditions:
  Low birth weight, bacterial infection
Symptoms:
  Post-admission - anemia, respiratory distress
Tests Conducted:
 
Chest radiograph:   shows pulmonary infiltrates
Arterial Blood Gas:   Low oxygen saturation
Hemoglobin:   1.8 g/dL
Diagnosis:
  Idiopathic Pulmonary Hemosiderosis
  Unknown
Treatment:
  Oxygen, ventilation, surfactant therapy
Allergies:
  Erythromycin
Outcome:
  Discharged

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coep-info@pharmacy.arizona.edu
Stefani Hines, Director: 520-626-3692
Marti Lindsey, Asst. Specialist: 520-626-7659
520-626-4468(FAX)

mailing address:
Southwest Environmental Health Sciences Center
University of Arizona College of Pharmacy, Room 244
PO Box 210207, Tucson, AZ, USA  85721-0207