Critical Care Medicine Simulation: 72-Year-Old Female with Fever, Hypotension, and Altered Mental Status

A 33-month-old with fever and altered mental status.

A 33-month-old girl presented with 3 days of fever and 1 day of multiple paroxysmal episodes of screaming with apparent unresponsiveness, flexed lower extremities, clenched hands, and upward eye deviation. These events lasted seconds to a minute at a time and occurred only during sleep. She slept peacefully between episodes and was easily awakened. She had a history of mild speech delay and mil...

An 8-year-old boy with Fever, axillary ulcerative lesion, and altered mental status.

Figure 1. Left axillary lesion Figure 2. Wright stain of the patient's CSF sample, revealing 87% lymphocytes (including many atypical lymphocytes) and 13% neutrophils. Diagnosis: tularemia with meningitis. After the lumbar puncture was performed, intravenous cef-triaxone was added to the patient's vancomycin therapy, and later that day, treatment with intravenous doxycycline and gen-tamicin was...

A 16-year-old boy with altered mental status.

and colleagues discuss hard-to-diagnose cases. A 16-year-old boy was transferred from an outside hospital for evaluation of altered mental status. Earlier in the month, he had begun having feelings of nervousness and anxiety. He reported hearing voices and having visual hallucinations. According to his parents, these symptoms had begun after the patient had been out clubbing with his friends; h...

Photo quiz: A 58-year-old female with altered mental status.

DIAGNOSTIC DILEMMAS AND CLINICAL REASONING A 33-Month-Old With Fever and Altered Mental Status

A 33-month-old girl presented with 3 days of fever and 1 day of multiple paroxysmal episodes of screaming with apparent unresponsiveness, flexed lower extremities, clenched hands, and upward eye deviation. These events lasted seconds to a minute at a time and occurred only during sleep. She slept peacefully between episodes and was easily awakened. She had a history of mild speech delay and mil...