A septic pulmonary embolus occurs from the embolisation of an infected thrombus – typically from an infected source such as an abscess – that enters the venous circulation, implanting in the lungs, which in turn causes a parenchymal infection. This case discussion gives a candid reflection on the treatment and management of a patient who was a known intravenous drug user, with a past history of a deep vein thrombosis and new presentation of a groin abscess. He was initially reviewed by a trainee advanced clinical practitioner, working out of hours in a hospital setting. This article will reflect on the patient presentation, the clinical examinations and investigations undertaken, which finally led to the diagnosis of septic pulmonary emboli. Although this condition is rare, having a high index of suspicion in patients with known risk factors may lead to early diagnosis and successful treatment.
This article examines a case study from clinical practice from the perspective of a final-year trainee advanced clinical practitioner (ACP) working within the hospital out-of-hours team in an acute hospital. To maintain privacy and patient confidentiality in accordance with the Nursing and Midwifery Council (2018)Code, the patient will be given the pseudonym James.
James was a 38-year-old man with a past medical history of recreational intravenous drug use of approximately 13 years, asthma and a previous deep vein thrombosis (DVT). James had been prescribed an anticoagulant, oral apixaban 2.5 mg twice daily, to prevent the re-occurrence of the DVT; however, he admitted that his concordance with self-administering this was often poor. James had been admitted under general medicine with an infected groin abscess, caused by injecting into the femoral veins within the groin, and was commenced on a 6-week course of the intravenous antibiotic, benzyl-penicillin, via a central venous access device (CVAD) as his peripheral veins were inaccessible. This treatment regimen had been advised by the microbiologist, following discussions with the parent team on admission.
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