Journal of Harza Hospital

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Case 1:
A 55 yr old male presented to a clinic associated with Harza Hospital complaining of severe headaches, sweating and abdominal pain. His blood pressure was 180/99 mmHg. He did not have any history of hypertension medications nor did he have the classic symptoms of cardiac disease such hyperlipidemia, diabetes ect. ECG revealed tachycardia however his blood metanephrine levels were elevated. He was diagnosed with pheochromocytoma. This is a condition where there is excess catecholamines from chromaffin cells (a rare tumor). He was taken into surgery and given phenoxybenzamine along with propranolol beforehand.

Case 2:Military Trauma Unit
A 33 yr old soldier was taken in from a blast site where he had sustained crush injuries to his left leg proximal and distal to his knee along with ribs 3-5 fractured on the left. He also had multiple contusions all over his body. In this particular case, along with the usual ABCDE of Trauma care there should be focus on hyperkalemia as potassium spills from stressed or damaged cells in large quantities. The Military Medic Corp (MMC) has assigned Potassium Kits and procedures. Initially calcium gluconate is given to stabilize the cardiac cell membrane from the effects of the high potassium levels and prevent progression into ventricular fibrillation. Then Insulin + glucose is given to push potassium back into cells and finally dialysis or Kayexelate is given to get rid of excess potassium from the body.

Case 3:
Lead intoxication occurs when patients work on houses or stay at houses older than 1970 (eating paint chips in the case of children), work in shipyards, battery factors or drink moonshine. The government has made it illegal to sell moonshine. Symptoms are abdominal pain, wrist or foot drop and eventual encephalopathy. The therapy is EDTA, succimer or dimercaprol.

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Jaundice A 44 yr old male came to the Harza hospital clinic downtown complaining of abdominal pain, jaundice and vomiting for the past two days. He recently returned from India. Physical exam revealed RUQ pain and lab analysis indicated elevated liver enzymes. HBsAg was not present (no hepatitis B infection) and HBcAb was positive. However he was also positive for IgM anti-HEV ab indicating Hepatitis E infection acutely. He had been exposed to hepatitis B before as he worked in healthcare. The government warns Hepatitis E in endemic nations.

Emergency A 33 yr old female presents with seizures for more than 34 minutes. She was initially given benzos but failed and so was given fosphenytoin in the Emergency department. The ED physician prepares barbiturates and intubation which is necessary eventually. The algorithm essential for status epilepticus is benzo, fosphenytoin, barbiturates, and then intubation for airway protection. The patient is currently in ICU. The cause of the seizure is likely intoxication.

GI Unit Beta: A 24 yr old female presents with RUQ pain, nausea and vomiting. The pain started after having pizza and ice cream with friends at University Ocra. She presents to the Harza University Clinic (HUC) with the presentation. RUQ palpation causes retraction. => This is a diagnosis of cholangitis. Dr. Mary Utter explains about another patient she saw with fever, RUQ pain and jaundice diagnosing him with cholangitis an infection of asending bacteria up the biliary tree. Patients can also present with a pentad: fever, RUQ pain, jaundice, altered mental status and hypotension. This is caused by obstruction of the common biliary tree by a stone.

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Congestive Heart Failure Strategy
Harza dept of Cardiology has developed a general policy dealing with congestive heart failure. It involves the concept of wet/dry and cool/warm. Wet/dry refers to fluid in the lungs secondary to hydrostatic pressures. cool and warm refers to perfusion capacity of the heart. The following are the scenarios

1) Cool and Wet = Diuretics to take water out of the lungs + ionotrops to help with perfusion of the periphery. Dobutamine ($200 by PharmInc) is the primary ionotrope used. Furosemide is the standard diuretic.

2)Warm and wet = Diuretic to take water out of the lungs + vasodilator to reduce the load on the heart

3)Cool and dry = IVF to provide blood pressure assistance + ionotrope

4)Warm and dry = this is the stable condition of the heart

Harza hospital recommends use of these standards in most hospitals

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The Military trauma team brought in a 33 yr old marine after a skirmish with terrorists. When asked where he was he answered "I want Ice cream" and looked dazed and confused. His heart rate was 122 and his blood pressure was 89/77. He was given IVF and Norepinephrine was placed on hold if the IVF did not aid in stabilizing the patient. Norepinephrine is the first line agent used if IVF are not enough to stabilize the patient. It affects the alpha 1,2 and beta 1 receptors both increasing heart rate and also vasoconstriction vessels. In this case the soldier has lost 1500 - 2000 ml of blood.

< 750 ml blood loss: There will be no symptoms
1000- 1500 ml: You will have 100 HR and anxiety
1500 - 2000 ml: you will have 120 HR and confusion
> 2000 ml: You will have 140 HR and lethargy


Infectious Disease Dept A 23 yr old patient presents with a bulls eye rash on the left medial shin. She was on a camping trip in the woods in Mass. She did not notice any tick bites. She was dx with Lyme and given Doxcycline. She then had hypotension, headache, chills, rigors and tachycardia reminiscent of sepsis.