Yes, this is E.MK's best case ever mini podcast series, and I'm your host, Dr. Anton Hellman.

This is the third of our series, Carr's cases, with the one and only Dr. David Carr.

This series, again, is about diagnoses that seem like they might be zebras,

but in fact, they're not so rare that you really need to know about. This particular one was

written up in the most recent C-GEM journal, along with one of our All-Star residents, Dr. Joel

Lockwood. So I'm working in a minor shift, and one of the jobs as being the minor doc is I get to review all the old lab work, all the abnormal cultures. That's a real fun part of our job, isn't it? So one of my charge nurses comes up to me and she says, Dave, you're going to kill me. I said, what are you talking about? So you remember that patient? You know, there was some patient who was here a few days ago. I showed you the cultural result. It was MRSA positive. You

weren't overly excited. It was an abscess. I said, yeah. He said, well, I called her to see how she was feeling like you asked. And she said, she feels horrible. So I'm bringing her in. And I said, oh, that's okay. I don't mind. If she feels horrible, we should see her. So, I don't know, two hours later on my shift, it's the

middle of July and I go see this 33-year-old young female. She's wearing a trench coat in a Montreal

Canadian's hat and she's head down, face down. Now, apart from she was wearing a Montreal

Canadian's hat, that wasn't the biggest problem here. The biggest problem here is it's July and

she's wearing a full trench coat and she's got rogers and she's lying face down in my minor area. I have no idea that this is the person

with the abnormal culture result, but then I realize this is her. It doesn't add up. So I said,

what's going on? She's a 33-year-old female who presented with a super pateller abscess around her left

knee. She was seen in our emerge about

three days prior, for which an incision and drainage was correctly done. Now, at that point,

the decision was made to give her some ANCEF, not a medication to cover MRSA or anything like that,

but she was given a dose of ANCEF and she was sent home. She came back to the emerge two days later and it was getting a little bit worse.

And the treating physician at that time did a really good job to improve the incision and

drainus.

And then he suggested placing her on SEPTRA for seven days, one tablet double strength.

And that seemed to be really doing the part. We got the

culture back two days later, so this is when I get involved, and it shows that she has MRSA. And

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