Your patient is a 26-year-old African-American male who is alert but in severe distress, complaining of pain in his hands and feet, as well as abdominal pain. The pain began this morning but has progressed from an initial rating of 5/10 to a 9/10 at the present time. The patient has a history of sickle cell anemia and denies any trauma. Physical examination reveals cool, diaphoretic skin; pain with palpation to all four abdominal quadrants; splenomegaly; and a priapism. HR = 132, BP = 140/90, RR = 16. Select the most appropriate acute diagnosis and treatment for this patient.
A) Sickle cell vaso occlusive crisis; administer high-concentration oxygen, IV therapy with isotonic crystalloids, and narcotics for pain control
B) Sickle cell trait; administer oxygen according to pulse oximetry readings, and give a 500 mL bolus of isotonic crystalloid solution
C) Sickle cell occlusive crisis; administer oxygen by nonrebreathing mask, isotonic crystalloids, and aspirin
D) Sickle cell disease; administer oxygen according to pulse oximetry readings, start an IV of normal saline, and administer ketorolac for pain
Question 2
An 86-year-old male has had a sudden change in mental status and is repeatedly striking a fist against his leg. When you question him, he does not respond. This presentation is most consistent with what condition?
A) Seizure
B) Dementia
C) Stroke
D) Delirium
Female choice based on male appearance.
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