8/11/2019 Sepsis 6 presentation
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Sepsis 6 ExamplesDr Andrew Robertson
8/11/2019 Sepsis 6 presentation
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Sepsis 6
J.H. 67M Bkgd: High cervical spine injury 2011,
tetraplegia & long term catheter; prn
ephedrine/nif. NH care.Admitted following difficult routine
catheter change + haematuria.
Catheterised and due d/c
Became unwell ~20:00
SIRS 4 inc pyrexia 20:50sepsis 6
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Sepsis 6
2050: O/e Unwell, clammy, anxious,nil else
T 38.0, BP 83/51 (134/78),HR 110
(130), RR 26 High flow O2
BCs (+urine cultures)
Colloid fluid challenge (+IVI) Lactate + VBG
Hourly UO
Gent Px 2132, Gent given 2155.
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Sepsis 6
HAN & Anaesthetics
BP 85/50, HR 80, UO 35ml/hr on 2L +
reg eph.
prn eph, if BP/ UO fallLevel 1.
Short ITU stay, quick recovery on
gent.
Suprapubic insertion.
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Sepsis 6
P.S. 61MAdmitted with abdo pain/ D/V, dark
urine, rigors, fever, anorexia.
o/e unwell, bibasal creps, LIFtenderness
P) Bloods, IVI, Abx, CXR, CT, seniorr/v.
Gelofusin given: started to feelwheezy & rigor.
1650: T 39.5, HR 130 (93), BP initially
unobtainable, 94/52 (75/57).
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Sepsis 6
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Sepsis 6
1650
O2
BCs
Abx (amox and metro, gent withheld forU+E)
Colloid
Lactate + ABG Hourly UO (and subsequently
catheterised)
1750
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Sepsis 6
ITU admission with Ecoli (BCs) gram
ve rods (urine) obstructive urosepsis
(L renal stone) and AKI.
Good recovery with IV Coamox/ gent(aciclovir), inotropes and retrograde L
JJ stent.
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Sepsis 6
Y.O. 51F
Admitted with SBO.
Laparotomy and correction 8/6/12
RTW 11/6
13/6 Well, light diet commenced
14/6 Flatus, but nausea, anorexia,
unwell
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Sepsis 6
10:30 ATSP Hypotensive, HR 94.
BS sluggish, mild tenderness, PR
empty ?ileus
P) Fluid challenge, ondansetron,laxatives
500ml NS.
BP 84/50; HR 96; JVP up; ECG NAD
8/11/2019 Sepsis 6 presentation
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Sepsis 6
14/6 1500 Pyrexia 38; SIRS 1 but~BP.
O2, BCs (+bloods), (Colloid) 1513. Px
ABxABG 1527
Abx 1530
Catheter 1545 (hourly UO).
Blood results: ALT 3327...
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Sepsis 6
Always if SIRS>2 + Pyrexia +Suspicion
To consider:
History & Examination!
?Sepsis ?Alternative
Urine/ sputum cultures, imaging,
bloods....
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Sepsis 6
Sepsis 6 sticker ?Y.O.
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Sepsis 6
W.M. 86M
Bkgd: CVA, dysphasia + mild dementia
Admitted because suprapubic catheter
not draining ?bladder mass & BP 76/40,HR 96.
On admission T38.2, BP 63/31, reduced
GCS.Sepsis 6
o/e dysphasia, tender abdo, suprapubic
mass
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Sepsis 6
~1500 Triple therapy, stat fluids,catheter drainage, O2, Cultures,
Bloods, DNAR
Refractory hypotension despite statIVI in 2 lines
Hypoglycaemia 3.6
Patient died 2030 Bloods: Na 129, K 4.8, G 2.8, Cr 363