Sepsis

James chats with David Anderson, Advanced ICU Trainee about a patient who has a high temperature and whose blood pressure is dropping alarmingly. What is the approach to sepsis on the wards?

Editor:  James Edwards

Interviewee: David Anderson

About David Anderson

David in an intensive care medicine fellow at RPA Hospital. His interests include end of life care, medical education and pre-hospital 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: #Antibiotics,#fever,#hypotension,#ICU,#infections,#inflammation,#intensive care medicine,#lactate,#low blood pressure,#sepsis,#shock

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