Problem
Joan is a 76-year-old female with a past medical history of hypertension, hyperlipidemia, patent foramen ovale an anticoagulated on Eliquis hypothyroidism rheumatoid arthritis, diabetes mellitus types 2, venous insufficiency bilateral lower extremities, closed fracture of the sacrum and anemia who presented to the emergency room on 03/29/2019 Status post fall. The patient reportedly fell at home and was down for over 48 hours. She was last seen on Friday 1/2018 at her PCPs office due to cellulitis of her left lower extremity. She was subsequently prescribed Bactrim DS. The patient reported that she had lost balance and fallen between her bed and wall it was wedged. She denied hitting her head. She did state that she scratched her back on the side when she fell, she denied ETOH.
Hospital course and summary:
On arrival at the hospital determined patient met SIRS criteria due to being febrile and tachycardic source of infection cellulitis of bilateral lower extremities. Patient was started on Rocephin and vancomycin. Lab work also determined the patient was in rhabdomyolysis secondary to the fall and prolonged downtime. CK initially 2303, trended down to 477 after being treated with IV fluids. The course of Joan was complicated, overnight 03/30/2019 stroke alert was called due to dysarthic speech and altered mentation. Imaging showed tiny acute infract in the left frontal lobe white matter. EEG showed no seizure. Duplex ultrasound of bilateral lower extremities was negative for DVT. Two echo was obtained that did not include a bubble study and did not mention PFO however prior echo mention PFO. Joan should follow up with cardiology outpatient regarding PFO she may require a repeat echo.
Task
What is the worst complication this patient might experience related to their priority concept? Why? How would you tell?