hey dr bernard here this video is based
on a case that's published in literature
link is in the description below i don't
intend to scare anyone about food or
leftovers i'll be eating leftovers for
dinner tonight just like i do every day
this was a freak accident happening in a
perfect storm sequence of events as i
will show you i publish a video every
month so if you hit subscribe and the
bell for notifications we can have some
leftover food together
a student ate his roommates leftover
noodles for lunch this is what happened
to his limbs jc is a 19 year old man
presenting to the emergency room with
muscle pain chills and shortness of
breath five hours earlier a purplish
discoloration that looked like bruises
had developed on his skin and his
roommate immediately drove him to the
hospital in the car jc could barely move
his head because his neck was so stiff
but it didn't matter anymore because his
vision was starting to go dark one day
earlier jc was on his regular schedule
he was hungry for lunch but it was cold
outside food wasn't easy to come by but
his roommate had gone out to eat the
night before and brought back leftovers
he's not really gonna care if i eat this
he wasn't gonna finish it anyways jc
thought immediately after eating the
meal of leftover chicken and noodles jc
didn't feel well he could feel a stomach
shake and convulse as the hours passed
jc could feel a blanket of pain covering
his stomach he felt like there was gas
but there was no flatulence a pool of
sour saliva flooded in under his tongue
and he felt a stinging sensation ripple
into his cheeks as he was brought down
to the floor he huddled over the toilet
as a stream of stomach contents pushed
up every couple minutes as he felt his
eyes squeezing out of his skull laying
down now in a world of hurt jc felt cold
he started shivering his arms and legs
felt weak and clammy and the blanket of
pain started spreading to his chest it
was getting harder to breathe his head
started pounding he slowly became
unaware of his surroundings when his
roommate came back jc couldn't turn his
head to look at him and his vision was
pulsating and starting to blur that food
must have been no good he thought i ate
your leftovers for lunch but they came
right back up jc said sorry i should
have just tossed it i didn't finish that
dinner because i barfed it up too his
roommate said as the night passed jc
could feel his heart pounding in his
chest his roommate was fine jc's head
hurt so bad that he was in a fetal
position the entire night what was it
about those leftovers he thought i
shouldn't have eaten them for sure he
thought as the sun started to rise jc
tried to get up to brush his teeth he
noticed some bruising on his arms and
legs that weren't there the day before
as he put the toothbrush in his mouth
but everything was in a state of pain
and it was just too much knowing that an
ambulance would be too expensive he
begged his roommate to drive him to the
hospital as he's brought to the
emergency room where we are now at
examination jc was responsive alert and
conscious but his skin was kind of pale
he had a fever jc's heartbeat was fast
heart rhythm was normal but his blood
pressure was high and he had tachypnea
tacky meaning fast and nia referring to
breath as doctors were examining him jc
empties his stomach all over the floor
doctors noticed it was a greenish yellow
color not really looking like any
particular kind of food doctors drew
some blood to test and to get a better
idea of what's happening but as the
minutes passed jc's tachypnea started to
get worse as he was gasping for air and
his face was starting to turn gray jc
has hypoxemia hypo meaning low ox
referring to oxygen and emia meaning
presence in blood low oxygen presence in
blood but how could this be he's
breathing faster than normal and it's
the same air everyone else in the
emergency room is breathing and no one
else is gasping like how jc is
doctors put him on supplemental oxygen
to try and fix this as the hour
continues jc's blood pressure drops to
half of what it was when he arrived to
the emergency room the nurse used a vein
in his leg to administer medicine to
stimulate his heart to try and get it to
beat harder to increase his blood
pressure doctors sedate him and stick a
tube down his throat so that a machine
can breathe for him but it wasn't enough
jc's blood pressure kept dropping but
then doctors started to notice a rash
containing small spots were emerging all
over his body at first this mottled
appearance looked like bruises but then
they became a deep reddish brown well
defined at the edges and multiple
lesions like this started appearing all
over his body but how could this happen
after eating food that made him and his
roommate sick the fever the sudden drop
in blood pressure the hypoxemia and the
diffuse rash all of this pointing to a
sudden terrible infection spreading all
over jc's body as doctors start him on
broad spectrum antibiotics they don't
know exactly what bacteria they're
dealing with they don't know what could
have caused this to happen the best that
they can do until they find out is to
give an antibiotic that covers many
different bacteria but things are only
getting worse doctors try to push more
medicines into his body to try to keep
his blood pressure up because it keeps
going down low pressure means that blood
can't get into his organs as they start
shutting down they call for a helicopter
because he needs to be transported to
another hospital with more resources in
the second hospital now doctors notice
that jc's hands and feet are cold
usually you can feel a pulse the heart
beating by the hands and the feet but
the medical team couldn't feel one for
jc the lesions look like more than just
bruises now and they've spread
everywhere occasionally jc would open
his eyes and he would just stare blankly
into the void his pupils still reacted
to light this reflex is natural in
humans and means that the brain is still
intact both of his pupils were the same
size so this tells doctors that his
brain is okay at least for now what
isn't okay is jc's kidneys at the
previous hospital before putting him
into the helicopter the medical team had
placed a catheter that's a tube that
will empty the urine in his bladder but
as it turns out there's no urine in his
bladder because his kidneys haven't made
any and they've completely shut down
another blood test finds that jc has
thrombo cytopenia throm from ancient
greek thrombose meaning a lump or a
piece cyto meaning cell and pina from
ancient greek poverty but in this case
referring to deficiency a deficiency of
cell pieces known as thrombocytes which
are also called platelets but what does
this mean you see blood has the ability
to coagulate it can clump together to
form a kind of jelly-like consistency
this is called a thrombus made from
thrombocytes another word for all of
this is blood clot this usually happens
in times where the body wants to stop
you from bleeding if clots are made of
thrombocytes but jc has a deficiency of
thrombocytes then it means that he can't
make any more new blood clots which
would mean that he can't stop bleeding
that could explain his bruise-like
rashes all over his body but jc doesn't
have a history of bleeding problems he
was healthy and fine less than 24 hours
ago before he ate his roommates leftover
food meaning at some time in between
this
thrombocytopenia developed if his
thrombocytes weren't low before but are
low now suddenly what happened to them
they could have been destroyed the
remnants of those destroyed would have
had to exit jc's body in some form but
where from he emptied his stomach
multiple times after he ate that food
platelets don't just float into the
stomach to be pushed out jc hasn't made
any urine so they wouldn't have exited
from there either so it's not likely
that they were destroyed instead this
could mean that jc's thrombocytopenia
could be because his body has consumed
all of his thrombocytes by making blood
clots everywhere in his body but where
exactly would they be when jc presented
to the emergency room at the first
hospital the medical team drew blood and
sent it to a lab so they can try and
grow the bacteria on the phone now with
the previous hospital the medical team
are told the results the species found
in jc's blood was nesseria meningitidis
the stiff neck the nausea declining
quickly into respiratory collapse and
shock the thrombocytopenia and
multi-organ failure the rash on his cold
hands and feet doctors had already
suspected
meningococcemia meningococcal bacteria
presence in blood by the time that these
results were confirmed but at less than
24 hours after eating his roommates
leftover food for lunch jc's kidneys
lungs heart and blood have all shut down
even though this is a meningococcal
bacterial infection it doesn't appear to
be meningitis the inflammation of the
meninges the membranes that protect the
brain and the spinal cord even though he
had a stiff neck called nuchal rigidity
but when he presented to the emergency
room he was conscious and everything
about his brain seemed to be okay
instead the bacteria flooded into his
bloodstream so this isn't meningitis but
meningococcemia but why is this
happening this brings us back to blood
clots we can already see where they are
when jaycee's body started to react to
the meningococcemia the immune system
started responding it's kind of like
getting a cut on your skin the bleeding
stops eventually because of blood clot
and then the area around the cup becomes
swollen and warm it's swollen because
the blood vessels dilate so that more
blood cells can get to the area and the
swelling is partly due to the fact that
there's increased fluid and warmth is
the inflammation but when bacteria is
present in the blood the entire body's
blood vessels dilate dropping the blood
pressure preventing oxygen from getting
into the organs thrombocytes are
consumed causing little clots to form
everywhere as they get lodged into small
blood vessels blocking blood flow as his
hands and feet become cold they're
starving of oxygen a pulse can't be felt
because nothing is flowing through as
the tissue starts to necros the bruising
happens because the remaining blood that
didn't clot has become thin and is
flowing out looking like a bleed all of
this is called purpura fulminance
feminines from latin falmen meaning
lightning or thunderbolt in this case
referring to something happening
suddenly and purpura from greek
referring to the color of the bruise
that appears suddenly as the days pass
jc is stabilized but parts of the tissue
on his fingers have necrosed and caused
gangrene both of his legs down to his
feet were also necros to the point that
they needed to be amputated because the
tissue can cause even more problems if
it starts floating around jc's body and
then they were amputated the neisseria
meningitidis bacteria is known to spread
through saliva not through the air which
brings us to the final point jc's
roommate threw up after eating parts of
his meal the night before these became
the leftovers that jc ate the next day
not knowing that this had happened this
kind of reaction is generally not normal
with food but as doctors got more
medical history on jc they found that he
only received the first dose of the
meningococcal vaccine just before middle
school and not the booster recommended
four years later at age 16. a second
serogroup b meningococcal vaccine is
usually required for people entering
university which also consists of two
separate doses given a couple months
apart jc had gotten this one but again
only one dose the evidence appears to
point to the food being bad and that is
a freak accident we'll never know
exactly what happened to it to cause it
to have neisseria meningitidis on it it
would be hard to even culture and grow
it specifically from the noodles but we
know that bacteria is transmitted
through saliva it made his roommate
throw it back up his roommate was up to
date on his vaccination schedule this
bacteria doesn't just materialize out of
nowhere and it caused this infection it
caused parts of jc's limbs to necros and
the missed partial vaccines twice on
jaycee's part was another accident that
happened at this particular place at
this particular time as jc's organ
function starts to come back 26 days
later he becomes conscious again and
he's moved to the step down unit as his
condition starts to improve blood
products were given to him to replenish
the correct coagulation factors in the
icu and other anticoagulants were given
aggressively the bacteria was handled
promptly with the correct antibiotics
but the illness caused by it lasted for
days he isn't critically ill anymore but
he has permanent changes on his body now
as he was able to make a recovery thanks
so much for watching take care of
yourself and be well