Yeah, purulent drainage from the cervix. Got the culture. Oof. Looks like we have our source. The positive urine this morning was contaminated.
Maybe.
Definitely. Not-so-clean catch specimen.
This infection's been brewing for a while.
So the car crash was a coincidence.
Not necessarily. She was probably already septic as the disease progressed, dropped her BP, and passed out while driving.
She wasn't hypotensive when she arrived.
Adrenaline rush from the car crash and the sternal fracture raised her BP but not for long.
Oh. No history of fever.
Bet she was taking Tylenol for the pain.
Let's call ICU for an admit. Also want gyn to see her.
She had mild lower abdominal pain and a positive urine dip. No fever, no back pain to indicate pyelonephritis. She was alert, walking, talking. It just seemed like a simple UTI. I saw no reason to have her wait eight hours for a bed for a pelvic exam.
McKay. Every postpartum patient needs a pelvic exam to rule out endometritis.
Wait, you're saying that with 20/20 hindsight.
Did you ask about Tylenol or ibuprofen use? Because that can mask a fever.
There was no fever.
Did you do a careful abdominal exam?
It was a quick chair exam, and there was only mild tenderness over the bladder.
Perhaps there was something about the patient that made you overlook proper treatment.
Like what, other than the obvious health risk factors?
Her size doesn't inherently make her unhealthy.
Are you saying I was biased against the patient because of her weight?
I raise it as a possibility, not as an accusation.
Wow. I mean, I really don't think that's the case here, but I will look out for it. Yeah.
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