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At the urgent care, you are seeing a 28 year old female. She is diaphoretic and disoriented and has a temperature of 100 degrees Fahrenheit. The patient complains of anxiety and disorientation and is unable to sit still. What do you suspect is causing the patient’s symptoms?
Your patient Janice says she had a busy evening and made dinner late. As a result, Janice thinks she might have eaten some raw chicken. She awakes with severe nausea, diarrhea, abdominal pain, and fever and barely makes it into your practice for an urgent appointment. What is the biggest risk of eating raw chicken?
At your urgent care the NP is treating 46-year-old female. She reports severe abdominal pain, nausea, and vomiting starting approximately six hours ago. The symptoms have steadily worsened. The pain is severe, sharp, and centered in the right upper quadrant, radiating to her back and right shoulder.
On exam, the patient is diaphoretic and appears quite ill. Vital signs show blood pressure of 135/75, pulse 95, temperature 100.9, respiratory rate 25, and oxygen saturation of 99% on room air. There is tenderness to palpation in the right upper quadrant with rebound, guarding, and a positive Murphy sign.
Laboratory findings are significant for elevated CRP and WBC count of 11,000/mm3.
A right upper quadrant ultrasound shows mild gallbladder wall thickening, but inconclusive evidence of stones or pericholecystic fluid.
What is the next best diagnostic step?