Modul Bjarne Day 0
Laboratory values
In the following we take a look at Bjarne’s blood analysis on admission on Day 0. Patient blood is used to measure the most important parameters in order to narrow down the list of possible causes for disease. If you want to re-read the explanations of the various parameters, look at the table of explanation.
Erythrocytes are red blood cells. If a person has too few of these, problems in oxygen transport are the result. Too many erythrocytes is a rare finding except in the case of long-term lung diseases or a few diseases of the bone marrow.
Leukocytes are white blood cells. This is a collective term for all cells in the blood which are responsible for the immune response. In a case of infection the leukocyte count rises very quickly, and the more severe the infection the higher the count.
Thrombocytes are blood platelets. They are responsible for blood clotting following injury, and the thrombocyte count can be higher or lower than normal for a variety of reasons.
Sodium is the most important cation in blood. Sodium is responsible for part of the osmotic pressure of the blood and thus has an effect on the amount of water contained in the blood. If the level of sodium is too high or too low, the water in the body is quickly redistributed, and this can be life-threatening.
Potassium is important for the conductivity of nerve and muscle cells. Too much or too little potassium in the blood triggers cardiac arrhythmia. Although the body closely controls the level of potassium, it can easily be upset through the introduction of medication.
The blood sugar level indicates how much glucose is contained in the blood. Glucose is the primary energy source for practically all cells. The blood sugar level is controlled by means of insulin and many other hormones. In diabetes mellitus this regulation process is impaired and the blood sugar level is too high. Very high blood sugar levels can be fatal.
The C-reactive protein (CRP) is a protein in the acute immune response against infection. Once an infection has been detected by the immune system, CRP is released from the liver and aids in the defense against infection. In medical diagnosis it has become established as the most important blood marker for infection in the blood.
The term O2 saturation is used to designate the proportion of hemoglobin in the blood which is saturated with oxygen. This value indicates how well capable the lungs and breathing are in supplying the body with oxygen. In the case of chronic lung diseases, these values can be continuously low (< 85%) without the patient noticing any symptoms. Below 80% organic function is impaired; below 60% unconsciousness occurs.
Laboratory
Here you find the laboratory values for Bjarne Pressler on admission on Day 0. In the column ‘Normal range’ you find the normal values. Mark to indicate whether Lilly’s values should be considered conspicuous.
| Parameter | Normal range |
Unit | Admission | Conspicuous |
| Erythrocytes | 4,3 – 5,75 | x 10^12/l | 5,7 | |
| Leukocytes | 3,9 – 10,2 | x 10^9/l | 13,5 | |
| Thrombocytes | 150 – 370 | x 10^9/l | 340 | |
| Sodium | 136 – 145 | mmol/l | 140 | |
| Potassium | 3,5 – 4,5 | mmol/l | 4,0 | |
| Blood sugar | 2,76 – 5,89 | mmol/l | 6,1 | |
| C-reactive protein (CRP) | < 5,0 | mg/l | 14,8 | |
| O2 saturation | > 94 | % | 91 |
Lung function
In the following we take a look at the examination of oxygen uptake, respiratory volumes and the bronchial system with the aid of various instruments. If you want to re-read the explanations of the various parameters, look at the table of explanation.
This is the air volume between the deepest possible inhalation and exhalation, in other words, the largest breath the patient can take. The value is an indication of possible limitation in lung volume, but does not provide any information on the cause. This value may be altered in the case of advanced degeneration due to smoking or infection.
The volume of air which leaves the lung during one second of the most rapid possible exhalation. Reduced values suggest an impairment in the air flow in the bronchial tubes and classically occur in diseases which constrict the bronchial tubes, such as bronchial asthma or cystic fibrosis. In cystic fibrosis FEV1 is used as a quick test of the acute condition of the lungs since a large volume of mucus reduces the value.
Here you can find the lung function values for Bjarne Pressler on admission on Day 0. The normal range is 80-100%. Mark whether Bjarne’s values should be considered conspicuous.
Lung function (normal range 80 – 100%)
| Parameter | Admission | % of the norm | Conspicuous |
| VC | 3,86 L | 75 | |
| FEV1 | 2,19 L | 52 |
Microbiological results
Concentration on agar & Microbial load
Next we will consider three parameters:
Today, precise identification of bacterial species is performed using complicated but very quick methods of mass spectrometry. Identification is important as it is used in making a preliminary selection of antibiotics, since not all antibiotics work against all bacteria. The final selection of a medication is based on measured resistances and on patient information (e.g. allergies).
This provides a rough indication of the number of bacterial cells on the agar plate using categories such as ‘dense’, ‘substantial’, ‘thin’ and ‘isolated’.
The microbial load is a more precise indication of the number of bacterial cells per milliliter of material. It can be determined by counting the colonies or by means of quantitative molecular biology methods.
Material: sputum
Query: pathogen identification
Results of culture:
| Day | Pathogens | Concentration on agar | Microbial load (cells/ml) |
| Admission | Pseudomonas aeruginosa | dense | 8x 10^7 |
Determining resistance with the Kirby-Bauer test
Enter the measured values and mark to indicate which antibiotics Bjarne Pressler’s pathogens are sensitive/resistant to.
Tip: If the diameter of the zone of inhibition is below the breakpoint limit, the patient’s pathogens should be considered resistant to the antibiotic in question. If the diameter of the zone of inhibition is above the limit, the patient’s pathogens should be considered sensitive to the antibiotic in question.
Resistances:
| Antibiotic | Resistance threshold
(mm) |
Zone of inhibition
(mm) |
Admission
sensitive resistant |
| Ciprofloxacin | 26 | ||
| Gentamicin | 15 | ||
| Meropenem | 24 |
Information on the antibiotics
Bacteria-killing antibiotic from the class of fluoroquinolones. It works by inhibiting a bacterial enzyme which is needed in copying the DNA during cell division. It works well against a broad spectrum of bacteria and is often applied in everyday medical practice for non-life-threatening infections. In the meantime, many resistant strains of different pathogens exist worldwide.
Bacteria-killing antibiotic from the class of aminoglycosides. It works by inhibiting protein synthesis at the bacterial ribosomes. Its effective spectrum is not as wide as that of ciprofloxacin, but it works well against Pseudomonas aeruginosa. Resistances exist worldwide in a few percent of bacteria.
Bacteria-killing antibiotic from the class of β-lactams and therefore a relative of penicillin. It works by disrupting the building of the bacterial cell wall and covers a very wide spectrum of dangerous pathogens. It is often used against Pseudomonas aeruginosa.
New scientific findings
The microbiological techniques applied in diagnosing infections have not developed much since the 19th century. Many of the methods already used by Louis Pasteur and others at the time are still in use today in everyday clinical practice (Carlet et al., 2012).
As an example, let us look at the Kirby-Bauer test for identifying antibiotic resistance. The test takes 24 hours – but today we know that bacteria can evolve even within these 24 hours. This means that within these 24 hours changes could take place with the result that the choice of a therapy based on the test from the day before could look quite different even 24 hours later. Even outside the treatment of cystic fibrosis patients, the long duration of the test poses a problem, as most infections are not correctly diagnosed at all and antibiotics are thus often prescribed on gut instinct (Carlet et al., 2014).
And so it is essential that new and faster diagnostic methods are developed in order to identify the resistance of a pathogen as quickly as possible (Carlet et al., 2014). This would make it possible to prescribe the suitable antibiotic to the patient more quickly.
Patient consultation
Bjarne Pressler
“Well, of course I notice that my lungs don’t want to work the way I’d like anymore. But I’ve had the infection for so long that I’m still pretty satisfied. I still take the dog for a walk twice a day, and I can breathe well enough while doing so. It’s only when I have to climb two flights of stairs that I notice a shortness of breath. At the moment everything has been stable, though; I haven’t run a fever or coughed up more than usual.”
Notes on the patient consultation
Daily report- Day 0 Bjarne Pressler
