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Virgie Townsend

Apr 11 2018, 9:46pm

The parents of one 27-year-old who died are speaking out.

Carl Romm was never completely well after he returned home from the Army. During his service, he injured his right index finger and it wouldn’t heal. After three months and several procedures to save it, his doctors performed a partial amputation, and he received a medical discharge.

At some point during his treatment, Carl picked up a staph infection . Typically, staphylococcus bacteria live on people's skin and don't cause major issues, but they can become dangerous if they reach a person's bloodstream or organs, which is what happened in Carl's case. Back home in Reno, Nevada, he wanted to go to University of Nevada for civil engineering, flip houses, get married, and have children. But he kept getting sick off and on. He had random coughs and bouts of the flu and bronchitis. He’d go to the doctor and get antibiotics for common infections and pain medication for his coughs, and he’d seem to get better, but not fully.

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“It would almost go away, but whatever he had going on would never truly vanish,” says his father, Chris. “He was never truly healed.”

Carl’s condition began to decline on July 2, 2010, his parents’ anniversary. He had a fever and chills, so although he was tired of seeing doctors, Chris convinced him to go the ER. Chris dropped him off, and then he and his wife, Joyce, headed for a baseball game. Chris assumed the hospital would treat and release him, and then he’d join his parents at the game. Instead, Chris got a call from a doctor that Carl was very sick and the hospital was admitting him.

The doctors diagnosed him with a bacterial heart infection and began treating him with antibiotics. After a few days, he was doing well enough to go home with a prescription for oral antibiotics. He was fine for his first day at home, but the fever and chills returned the next day, and it was back to the hospital. Over the course of several more visits to the hospital, he caught multiple infections.

“By the time we got him into the hospital the last time around, he had four or five ongoing bacterial infections,” Chris says. “He had a fungal infection. Three of them were antibiotic-resistant. The doctors were throwing everything at him, giving him every medication known to man. The infections just kept coming back and back, bigger and stronger."

Carl's parents and doctors were optimistic that he was going to get better. He’d undergone open-heart surgery to repair the damage that the infection had done to his heart, and was ready to be released. That morning, September 2, Chris stopped by the hospital to visit Carl before work. When he got to his room, he heard the water running in his bathroom, and thought Carl was in the shower. After waiting a little while, he knocked on the door. Hearing no response, he opened it and found Carl slumped on the floor.

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Stable Coronary Artery Disease

An RCT of 200 patients with severe single-vessel coronary stenosis (≥ 70%) found no differences between groups in exercise time or anginal relief six weeks after percutaneous coronary intervention or a sham procedure.

In a large RCT, older adults with no diabetes mellitus who had cardiovascular disease or at least a 15% 10-year risk of cardiovascular events were randomized to a systolic blood pressure target of 120 or 140 mm Hg. After three years, the group with the lower blood pressure target had less all-cause mortality (NNT = 83) and heart failure (NNT = 125), but more hypotension, acute kidney injury, and electrolyte abnormalities.

In three large randomized trials of high-risk patients with coronary artery disease and diabetes, liraglutide (Victoza), semaglutide (Ozempic), and empagliflozin (Jardiance) decreased cardiovascular deaths (NNT = 43 to 71 over two to three years).

NNT = number needed to treat; RCT = randomized controlled trial.

Enlarge Print

CAD = coronary artery disease.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort .

SORT: KEY RECOMMENDATIONS FOR PRACTICE

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MICHAEL M. BRAUN, DO, is director of inpatient medicine for the Department of Family Medicine at Madigan Army Medical Center, Joint Base Lewis-McCord, Wash. ...

WILLIAM A. STEVENS, MD, is chief resident in the Department of Family Medicine at Madigan Army Medical Center.

CRAIG H. BARSTOW, MD, is director of the hospitalist fellowship at Womack Army Medical Center, Fort Bragg, N.C.

Address correspondence to Michael M. Braun, DO, Madigan Army Medical Center, 9040 Fitzsimmoms Dr., Tacoma, WA 98431 (e-mail: michael.m.braun.civ@mail.mil ). Reprints are not available from the authors .

Author disclosure: No relevant financial affiliations.

1. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons [published correction appears in Circulation . 2014;129(16):e462]. Circulation . 2012; 126(25):3097–3137. ...

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