Work last night was busy in the Emergency Department. Busy busy busy. Not only was there at no time an empty "to-be-seen" box, but, at one point, the people to be seen were literally filling up all the chairs in the acute area. And they were still pouring in. My shift started at 1600 and I did not have time for my dinner until my shift ended at 0045 (45 minutes of overtime).
I saw a few interesting patients too. There was one anxious lady in her 20s who had had a spiderbite. She had managed to catch the spider and brought it (the dead spider) along in a film container. It had the body shape of a small redback spider but did not have the classical red streak running up its back. On examination, there was some local erythema (redness) and warmth at the spiderbite site, some local piloerection (hair standing on end) and some local sweating too. Her pain was only slight to moderate but it was advancing up her arm.
It was decided, after consultation with some senior staff members, that she did not qualify for redback spider antivenom as her pain was not severe enough (she fell asleep at one point) even though she did display some signs of envenomation.
Then there was a Lebanese woman in her 20s who came in with headache of 3 days duration, some neck stiffness, photophobia +++, fever, vomiting and looking somewhat unwell. She had been on paracetamol (acetaminophen) but that had brought little relief previously and no relief at all that day. Her father accompanied her and seemed to be of the opinion that she was going to get better by herself and that it all started after she used a new hair dye 3 days ago. She had no past medical history of note, was not on any medications, had no recent infections and had a family history of von Willebrand's disease.
On physical examination, she had limitation of neck movement (though not as much as the guy from the day prior to this) but her photophobia was, if anything, much worse. Her neurological system seemed fine - her upper and lower limbs were fine and her cranial nerves were mostly fine (I could not test her eyes because they were so painful she couldn't open them). Her chest was clear, her heart sounds were dual and her abdomen was soft.
We were going to do a lumbar puncture on her when we found that, on her full blood count, she had a platelet count of 41 (x1000/microliter), way below the accepted normal for her age range of 150. With that score, she was at risk of prolonged bleeding and we were reluctant to continue with the LP. Eventually, she had a head CT scan, which showed nothing (well, it showed a normal head CT). Her blood picture indicated it might be a bacterial infection but the clinical picture suggested a viral meningitis. To be on the safe side, she was started on IV (intravenous) antibiotics, being given a stat dose of 1g penicillin and 2g of ceftriaxone.
By this time, a couple other members of her family had arrived and I explained to them that we were unsure whether it was a bacterial or viral meningitis that she had. I told them that we could not tell for certain because we did not do an LP but that we were covering our bases by given IV antibiotics. The family was dumbfounded as to how a seemingly healthy young woman fell so sick within a few days. They were a little distraught when I told them that if it was a bacterial meningitis and we did not treat it, there was a significant chance of her dying from it.
You live and learn, I guess...
In other news, the Dow and NASDAQ managed to rally overnight. It smells a lot like a bear market rally (or bear trap, as some like to call it) so I think you would be well advised not to participate in this one unless it gained more legs -- a LOT more legs. The current conditions are a speculators heaven. Lots of money to be made on the short side.
The Japanese central bank has finally done it. ZERO percent interest rates. The move was largely symbolic as the interest rates were already at 0.15% but that kind of news just sticks out like a sore thumb. They're trying to push liquidity onto the Japanese people, but I don't think that they're biting. We'll see. April 1st remains an important day for Japan as financial institutions must change their accounting policies by then to include mark-to-market prices, instead of their antiquated methods of carrying stock on whatever they think is book value. Some major banks in Japan could be in big trouble as they have to revalue stock holdings they might well be carrying since the stock bubble in Japan in 1989/90.
The price of gold perked up today, alongside another rise in the gold lease rates. This is the third time in a month that the lease rates are perking up, having fallen back a little recently. Maybe it will be third time lucky.