_ 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.
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.
_ 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)
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.
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).