ED COURSE/MDM/A/P:

_ meet >=2 SIRS criteria(36<T>38,HR>90,RR>20,wbc>12k,4k<bands>10%).

IVF empirically started. Urgent evaluation to elucidate source to guide abx regimen initiated.

Diagnostically:

 cbc (eval for luekocytosis)

 bmp (eval for elevated Cr c/f end organ damage)

 LFT’s, lipase (eval for hepato-biliary source or

 INR (sign of end organ (liver) damage from sepsis)

 lacate (marker for end organ hypoperfusion)

 CXR (eval for PNA)

 UA/UCx (eval for urinary source of infection, Cx for be followed up by inpt team)

 BCx x2 (to be followed by inpt team to further guide inpt abx)

_ no evidence of skin/deep space infection on full head/toe exam

_ CT a/p

  (Not indicated when: doubted to have intra-abd source for sepsis)

Reviewed indications, applied to this patient to inform appropriate use of diagnostics).

 _ LP deferred at this time given pt does not exhibit symptomatology consistent with encephalitis/meningitis and alternative suspected source elucidated.

Therapeutically:

IVF (30cc/kg)

_ suspected source based upon above evaluation, as such abx initiated

_ abx regimen

_ intubation (indications: inability to protect airway, inability to ventilate, inability to oxygenate, anticipated course)

MDM:

Suspect infectious etiology to pt’s symptoms.

Severity of sepsis:

_ sepsis given >=2 SIRS criteria with suspected source

_ severe sepsis given signs of end organ damage (e.g. SBP<90, lacate>4, bilii>2m UO<0.5ml/kg/h, Cr>2.2, plat <100, SpO2<90%)

_ septic shock given sepsis and hypotension after adequate fluid resuscitation. As such, pressors initiated (norepinephrine gtt).

_ suspected source.

DIAGNOSIS:

DISPOSITION: Admission

COUNSELLING: Patient/family educated on diagnostics, assessment, treatment plan. Patient/family amendable and in agreement with proposed plan. All questions and concerns addressed and answered.

*This information is intended for educational purposes only and not intended for use in patient care (which requires a trained credentialed attending physician and individualization of the medical care plan to the specific patient).