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Burn, Baby, Burn

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Burn, Baby, Burn is case #14 of House M.D. - Critical Cases.

Bobby Reed, a 14 year old student, was working alone in a biology lab when he suddenly noticed he seemed to have third-degree burns.  He collapsed on the floor, writhing in pain, until he was found by his father Phil, the school principal. The case was assigned to Dr. House.

House ordered his team to do an environmental scan, and they found a terrarium.  After using 19 chemical meds, 8 rolls of gauze and 1 ward favor, they identified  amanita bisporigera, a poisonous mushroom.  Although it would be dangerous if ingested, it wouldn't cause internal burns.

A further environmental scan finds a leaking pipe.  After using 1 ward favor, 5 syringes, $1,000 of the budget and 7 head meds, they find that although the building is old, the pipes do not contain lead.  This rules out lead poisoning.

Another environmental scan finds a roll of dirty paper towels.   After using 21 body meds, 1 ward favor and 8 rolls of gauze, they find traces of staphylococcus.  This rules out Graves' disease as it wouldn't result in burns.

Given the staph, the team treat Bobby for scalded skin syndrome by using $1,000 of the budget, 8 syringes and a ward favor.  However, despite treatment, he starts coughing up blood.  

Bobby goes code blue and has to be defibrillated.

House orders a round of imaging which shows that Bobby's intercostal muscles around his ribcage are in permanent contraction.  After using 2 ward favors, 23 digestive meds and 8 thermometers, they realize the muscles locked up from lactic acid buildup due to constant shivering.  This tightening of the muscles rules out benzodiazepine abuse.

More imaging shows that Bobby's abdomen is swollen with fluid.  After using 10 tongue depressors, $1,000 of the budget and 2 ward favors, they realize this symptom rules out sarcoidosis.

Another round of imaging shows a heart murmer symptomatic of anemia.  After using $1,000 of the budget, 5 oxygen masks. 3 ward favors and 11 gland meds, they rule out heart rhythm disorder

Bobby is treated for a gastric ulcer with 15 body meds and 3 ward favors.  Hoewver, he still has trouble breathing because of his ribcage contraction.  House notices that Bobby has stitches on his arm, which his father tells the doctors was due to "roughhousing".  However, all of a sudden, Bobby loses consciousness.

Once again Bobby goes code blue and has to be defibrillated.

The team perform a blood analysis and find low blood pressure.  After using 6 syringes, 3 ward favors and 19 chemical meds, they realize this is not a symptom of chemical poisoning.

A further blood analysis shows low electrolyte levels.  After using 3 syringes, 3 ward favors and 23 heart meds, the team rules out lymphoma as it causes high electrolyte levels.

Another blood analysis shows that Bobby has O+ blood, but there are traces of A- as well.  After using $1,100 of the budget, 3 ward favors and 5 body meds, they can rule out tonic seizure.

They give Bobby a plasma transfusion to treat a transfusion reaction with 4 IV bags, 3 ward favors and 27 body meds.  After questioning his father, Phil admits he gave Bobby a transfusion of his own blood after he was badly cut after being shoved into a wire fence by another boy.  Bobby had lost a lot of blood and had shallow breathing.  Phil had been a medic in the Vietnam War and also did Bobby's stitches.  The wrong blood type explained Bobby's damaged kidneys, which in turn explained the staph infection.

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