Sepsis

Editor:  James Edwards

Interviewee: David Anderson

James chats with David Anderson, Advanced ICU Trainee about a patient who has a high temperature and whose blood pressure is dropping alarmingly.

David in an intensive care medicine fellow at RPA Hospital. His interests include end of life care, medical education and prehospital care.  In addition to intensive care medicine he has spent time training in anaesthesia, retrieval medicine and palliative medicine and before qualifying as a doctor he worked as a paramedic.

Sepsis on the wards

with Dr David Anderson (ICU Advanced Trainee at Royal Prince Alfred Hospital, June 2013)

 

Case:

  • You are called to see a patient who has a fever of 38.9 and their blood pressure is
    85/40
  • Does the patient look unwell, vital signs, do they need a clinical
    emergency call?
  • Priority
    • High
  • Corridor thoughts
    • Source of fever, type of shock (distributive, hypovolaemic, obstructive,
      cardiac)
  • Go straight to the bed, general observation, feels the patients feet (warm or cold),
    infusions, look for source of infection
  • Review the notes – are they immunosuppressed, MRSA, post operative?
  • BC, VBG and lactate, FBC, UEC, CXR
  • Fluid resuscitation, broad spectrum antibiotics unless source identified, source control
  • Registrar review, if worried call for senior help and if so stay at the bedside to look for response to your treatment and provide a bedside handover, consider ICU review if no or temporary response to fluids
  • Document, inform nursing and your medical staff of your worries, may need further observation with instructions on when to call, make sure the treating team is aware
  • “The feet are the window to the soul in intensive care” Dr David Anderson

Related Podcasts

Tags: #hypotension,#infections,#lactate,#sepsis,#shock

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