From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: When diverticulitis leads to peritonitis and then to septicaemia 
	question.
Date: Sun, 17 Mar 2002 15:48:21 -0700
Message-ID: <a736ls$3cc$1@nntp9.atl.mindspring.net>

"CBI" <00doc@mindspring.com> wrote in message
news:a72skj$bbd$1@nntp9.atl.mindspring.net...

> As for when the second abscess should heave been diagnosed: no one here
> can tell you that. There is no reason to get a CAT scan on a person who
> does not have signs of an occult infection and who is progressing
> normally. Exactly what situation should have prompted additional studies
> and when they should have been done is a matter of judgment. An abscess,
> particularly in an elderly patient, can arise quickly and then rapidly
> progress to sepsis and death.
>
> CBI, MD



Yeah, the elderly can be toxic with astonishingly few symptoms. I had a lady
in her 90s once who came in with mild belly pain only, some nausea, but very
little tenderness. However, she had no bowel sounds, a low grade fever, and
bandemia (the last being a real emergency in geriatrics). Also clear urine
and chest, but a high lactate (which we do in everyone with belly pain). I
called the surgeon in, in the middle of the night, and he suggested maybe
just operating immediately, without the CT. I agreed. Sure enough, she had a
perforated bowel and a beginning abscess. But survived to go home a week
later.

This is very different than typical for younger people. At an Urgent Care I
worked at once a guy in his 20's came in with vomiting and abdominal pain.
He had a much higher temp and a board-like belly with severe right lower
quadrant tenderness. He went straight to the OR also (yep-- nearly
perforated appy), but it was a much easier call.

SBH

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: elderly woman with flu
Date: Tue, 19 Feb 2002 18:43:40 -0700
Message-ID: <a4uv8p$p91$1@slb2.atl.mindspring.net>

"Xena" <AgentXena@webtv.net> wrote in message
news:480-3C72DBD3-612@storefull-122.iap.bryant.webtv.net...
> I feel terrible about how things went today and I want to know if this
> was right. I think it wasn't.
>
> My grandmother is 76 years old and has had the flu the past couple of
> days and is so weak from it that she usually can't even get up and get
> to the bathroom without help. She went to the emergency room today and
> they didn't keep her there. They still expected her to leave even though
> she couldn't get up off the bed at first when she was released.
>
> We had an ambulance come to bring her to the emergency room because we
> thought she couldn't walk down the stairs (from the second floor) and
> the paramedics made her walk down them!
>
> Isn't it more dangerous when someone her age has the flu? I expected
> them to keep her a day or two to make sure she didn't get worse. She
> didn't even get the flu shot this year. They came in late and when it
> was time for her to get it she couldn't because she had a cold.


COMMENT

I'm not sure what you're asking. Are you complaining about the social
support system, or asking about the danger?

First, are you sure it's the flu?  She has a fever and chest infection,
right?  If she has some GI bug, it's not the flu.

The ER has doubtless looked at her oxygenation, her lungs, her blood
pressure when upright and fluid status, and they may have more confidence in
how she's doing than you do. People don't generally die suddenly from the
flu-- they first go through a phase where they can't go down stairs. You're
telling us your grandmother isn't there yet.

If you need home health basic nursing care (somebody to help get somebody to
the bathroom) it's in the phonebook. It's a lot less expensive than a
hospital, where they won't be doing much more for her than that anyway, so
long as she's drinking on her own, and her oxygen is good (which I presume
it is).

Now, of course, the difference is in who PAYS for home nursing vs the
hospital. If you had to pay for both, you might have a different opinion.
Still, medicare will pay for certain home health services. Call your doc and
get him/her to order some.

From: "Steve Harris" <SBHarris123@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: elderly woman with flu
Date: Thu, 21 Feb 2002 00:44:27 -0700
Message-ID: <a529ie$15r$1@nntp9.atl.mindspring.net>

"PF Riley" <pfriley@watt-not.com> wrote in message
news:3c749038.409927212@news.nwlink.com...
> On Tue, 19 Feb 2002 18:43:40 -0700, "Steve Harris"
> <sbharris@ix.RETICULATEDOBJECTcom.com> wrote:
> >
> >First, are you sure it's the flu?  She has a fever and chest infection,
> >right?  If she has some GI bug, it's not the flu.
>
> In pediatric practice, parents usually mean "acute gastroenteritis"
> when they say "the flu."
>
> >The ER has doubtless looked at her oxygenation, her lungs, her blood
> >pressure when upright and fluid status, and they may have more
> >confidence in how she's doing than you do. People don't generally die
> >suddenly from the flu-- they first go through a phase where they can't
> >go down stairs. You're telling us your grandmother isn't there yet.
>
> Hrm. I remember my father, ordinarily in reasonably good health, one
> late December, at age 61, emphysematous and febrile, stopping after
> each step on the small flight of about 5 stairs on the way to his
> doctor's office, panting several times before taking the next step. He
> was dead the next morning. But I never realized until now that one's
> ability to climb stairs is a good indicator of his proximity to death
> in old age!
>
> PF


In old age or any disease.  Ever hear of the Karnovski scale?  This doesn't
mean you can't die of a stoke, heart attack, or pulmonary embolism at any
time.  But you can do that on the golf course, and even if you feel great.
YOU could be dead by morning.  Should we hospitalize you now, just as a
precaution?

SBH