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Sat Jun 9 14:51:20 BST 2007

Update:

It is now one week post injury.  His Hb is starting to slowly climb back up
(9.4 g/dL today, 9.0 g.dL yesterday) ).  His WBC count is still mildly
elevated at 12.9 with 65% neutrophils on the differential - improved from
15,000 the day before.

He is tolerating solid diet and having bowel movements.

The left pleural effusion was drained and showed no organisms or WBC on gram
stain, and cultures are negative so far.

He had a *fever spike* the day before yesterday, and again yesterday (only
once each day).

But last night he complained of more than the usual *pain* in the left upper
abdomen - he is asking for iv narcotics again (hadn't done that in the last
48 hours).  He is tender there, although without much guarding.

And....one out of two *blood cultures* (taken during a fever spike to
39.0yesterday morning) is now growing gram negative rods and gram
positive
cocci.

options as I see them:

   1. Repeat the CT scan.  What if the scan shows no obvious abscess -
   just a busted-up spleen with perisplenic hematoma?  What would you see on
   the scan that would compel you to operate versus continue to watch?
   2. Start antibiotics and watch?
   3. Remove the spleen and be done with it?

Thanks
C. Ursic, MD
Santa Fe
USA

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