音声書き起こし 自動 - 実行
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Welcome to my case study today.
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I will be talking about a 45 year old male
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patient I will be referring to as e k.
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Throughout the presentation, Um, e K has eaten out of
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families barbecue.
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Uh, find out why he can't speak or move his
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limbs. And here's how it all started.
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You get called code three for a shortness of breath
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at a residence.
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Um, as you arrive at the residents, you are acquainted
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to me.
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Ikea. You meet E k in his kitchen at his
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residence and his chief complaint, shortness of breath and blurry
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vision, The further U.
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S S E k.
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Here are some clinical findings.
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So Ikea is 45 years old.
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He's playing, um, shortness of breath and blurry vision.
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He has had nausea, vomiting and diarrhea a few days
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prior. Um, and he states that he had the worst
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stomach pain on his life that day.
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But now he seems to be all good in that
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department. Although he's short of breath, Uh, okay.
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Is normally healthy, active male.
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He has no known allergies.
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He takes a daily vitamin.
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Um, he has a puffer for his asthma.
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And the last oral intake that he had was the
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other day when he tried to get some food down.
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Um, and he hasn't had a lot of fluids, he
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states. He tells you that he had attended a family
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barbecue and then ended up staying home the next day
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because he felt sick.
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And it seems to have progressed.
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E. K.
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Goes on to tell you that at this barbecue he
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had his friends homemade, canned, passed a sauce, which he
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said was absolutely the best thing ever.
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But he blames it on his nausea in his vomiting
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the next day.
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He also tells you that he hasn't filled his asthma
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puffer that he usually takes in a while.
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Um, and he feels like with his windows being open
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in his household, that, um, the weather seems to be
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affecting his breathing.
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You continue to assess E.
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K. He has had no stroke or brain injury recently.
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No signs of trauma.
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He doesn't have a fever.
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He's had no travel, no recent illness.
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Other than the nausea and vomiting and diarrhea he had
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the day prior.
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His S B 02 is a little bit low, so
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you started with some oxygen nasal cannula, and you're thinking
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of giving him some sell Beautiful for the shortness of
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breath. The rest of his vitals are as shown here
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on the right, And e K also seems to tell
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you that he just generally feels very weak when he's
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normally very active.
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You decided to start a line on him to rehydrate
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him as he's pretty dehydrated while en route to the
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hospital, E K E K decides to tell you that
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his mouth is very, very dry, and you start to
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notice that his eyelids are getting pretty droopy.
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The salbutamol doesn't seem to have made any difference in
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his shortness of breath is neither worse or better.
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You have now arrived at the closest hospital, and e
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K is progressively getting worse because this hospital seems to
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be very, very busy.
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You are left in the hall with Ikea to monitor
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him and stay with him.
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You noticed that he begins to develop even more severity
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of droopy eyes.
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Um, and he tells you that he starts to see
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double. His speech seems to be a little bit off,
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and eventually he's experiencing difficulty speaking and swallowing his respiratory
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rate raises and they are.
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He's more significantly short of breath.
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When you ask him to smile, it seems like he
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cannot, Um And he doesn't seem to speak back to
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you when you ask him questions.
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So you decided to give him a piece of paper,
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um, and can communicate with him that way.
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He tells you that he can hear you and that
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he can still see you.
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Although it's a little bit blurry and double.
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Um, he also tells you that he can smell and
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that he can still feel feel things.
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Um, although he notices that he has some tingling sensation
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in his fingers as the room gets cleared for Ikea
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to go into, um, he seems to definitely progress.
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Worse as that is happening.
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And you're handing off the information to the doctor.
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Um, he's intubated into the room and you get dispatched
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to a cardiac arrest.
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Your left leaving the hospital not knowing exactly what was
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going on.
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Was this an asthma attack?
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Um, what was this rapid progression of general weakness?
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Um, while you have done a neuro assessment with him
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in the bed in the hallway, everything seemed to be
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symmetrical. You did.
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And other people are very, um, check you check his
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pupils and they were fixed and dilated at six millimeters.
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You were left with the question of what was really
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going on.
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A few days later, you returned to the same hospital
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and are actually able to have a chat with the
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same doctor that you had left E k.
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With. So Ikea is now in the I.
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C U and Dr Bacillus fills you in that the
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patient had ingested spores from the canned goods at the
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potluck. Unfortunately, his friends past the sauce was the culprit.
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The bacteria, known as Clostridium botulinum, had entered the digestive
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track through the mucosal lining and into his bloodstream.
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Thus this progressing, descending general weakness had led to flaccid
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paralysis. Um, this would make sense for the reasoning of
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his droopy eyelids in his visual deficits.
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Um, with no other sensory deficits other than a slight
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tingling into his fingers, um, he had reported of no
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fever. And with his the history gathering and a serum
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test being done, botulism was the culprit.
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The emergency staff in admits of trying to figure out
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what was going on.
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One very important clue was this the progressive general weakness
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had started with a presentation of cranial nerve palsy.
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These bulb ours symptoms of difficulty speaking, chewing, swallowing, vision
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difficulties than descending symmetric weakness to eventually a flaccid paralysis.
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E k could not speak because he he was paralyzed
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because his weakness was symmetric.
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It was always a question between What is this a
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central cause or a peripheral cause?
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Central meaning of problems with the brain and spinal cord.
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But with a clean MRI coming back, Um, it seemed
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to be a peripheral cause the peripheral system had operated
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on muscles.
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So the real question was, Is there something wrong with
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the K's nerves?
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Is it his muscles themselves, or is it the neuromuscular
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junction? Other disease processes such as polio and West Nile
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would seem to present almost the same, but with a
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recent with no recent illnesses, Um, typically a respiratory illness
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would present first in fever, which E.
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K did not report fever.
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He was having problems with his ocular muscles in his
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respiratory system, which in conduct conjunction, um, didn't make sense
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together. But the Neuromuscular Junction botulism has an important role
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in once the bacteria had flourished in his gut and
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has made his way into the bloodstream.
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Um, the toxin is unable to meet the point of
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the priests synaptic neurons to two nerves to where the
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muscles meet in a neural synapses.
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Acetylcholine would be released by the snare protein to reach
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the muscle, causing contraction.
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Uh, botulism.
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The botulism toxin blocks the pre synaptic acetylcholine release and
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inhibits this muscle contraction that's causing the flaccid paralysis.
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There are many ways to test for this, um, toxin
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within the body.
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Um, serum testing was done on E.
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K. But there's also stool sampling and, um, checking inside
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within the gut.
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E k was treated with an anti toxin known as
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hefty Valence serum, which then sequesters the toxin into the
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liver and the spleen.
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Um, E K was monitored very closely with mechanical ventilation
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in a bowel irrigation.
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Um, close monitoring of his airway, his vitals, his oxygenation
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in his arterial blood gases.
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Dr. Bacillus fills you in a little bit more about
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some botulism facts.
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Um, that there are eight different types of strains of
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the bacteria, and most commonly, it's A and B that
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will affect humans.
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Um, there's many different types of ways to get botulism
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And it's not always through eating foods or contaminated foods
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such as, um, an improper canning of foods but also
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inhalation direct contact.
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And also there's, um, type of botulism known as infant
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botulism, where Children under the age of one who eat
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honey are so susceptible to botulism because their gut flora
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isn't as strong as someone our age.
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Um, the bacteria is easily able to flourish, and what
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is known as floppy baby can occur.
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E K was later released from the I.
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C. U with a full recovery, thankful for a quick
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diagnosis and treatment of the antitoxin.