Issues:
1. Critically unwell patient with septic shock
Source – Respiratory, other
2. Breast Cancer
Is patient on Chemotherapy – consider febrile Neutropaenia
Is there metastatic disease Continue reading
Tag Archives: sepsis
Lab Case 11 – Interpretation
67 year old man presents 7 days post major surgery critically unwell. He has severe sepsis (high temp, compensated shock).
FOAM Eye-Catchers 7: SMACC GOLD Highlights
Having recently returned from the FOAM-ite mecca, SMACC GOLD, in this edition I take a look at just a few of the many highlights. Given there were frequently 3 speakers on at the same time, there were many talks that I missed so this is not an all inclusive list by any means. Continue reading
Lab Case 11
A 67 year old man is brought to your Emergency Department by ambulance. He is 7 days post right total knee replacement, complaining of feeling generally unwell and a painful right knee. He has had a previous cholecystectomy.
Vitals:
BP 120/60, PR 140-160/min irregular
Temp 40 RR 20/min, O2 sats 90% RA
On examination:
Jaundice
Chest clear
Abdomen soft and non tender
Describe and interpret the following bloods: Continue reading
Lab Case 5 – Interpretation
The bloods show a mild neutrophilia and substantially deranged liver functions tests. She has jaundice, confirmed biochemically and the pattern of LFT derangement with all of the ALP, ALT and GGT elevated is a mixed one (suggesting both hepatitic and obstructive changes)
The most likely diagnosis given the clinical context is ascending cholangitis due to an obstruction of the lower biliary tract. The most likely aetiology is a gallstone. Another important cause is a tumour involving the biliary tract or pancreas.
This patient has a life threatening emergency.
Her priorities in ED;
- Aggressive IV fluid resuscitation
- Nil by mouth and NG tube (if ongoing vomiting)
- Analgesia – titrated IV morphine or fentanyl
- Antibiotics – parenteral broad spectrum, for example “triple therapy” amoxycillin /gentamycin / metronidazole
It is essential that her ongoing management be in a centre that can perform an ERCP as relief of her biliary obstruction is critical in resolution of the illness. The severity of such a presentation should not be underestimated. There is a significant mortality.
FOAM Eye-Catchers 4
Time for a Rethink on IV Fluids in Sepsis?
Earlier this year in March, I was fortunate enough to pilgrimage to the inaugural FOAMite mecca – SMACC (Social Media And Critical Care) Conference in Sydney. Quite frankly, it was the best conference I’ve ever attended. Some of the highlights included talks by Prof John Myburgh, in particular one on IV fluids in Sepsis, available for free via SMACC talk archive.
Recently Emcrit released a paradigm shifting lecture by Dr Paul Marik on fluids in sepsis that builds on some of the theme’s of Prof Myburgh’s talk. Not long after, Scott Weingart released his response to Dr Marik’s lecture.
All 3 talks are well worth listening to in full. However I’ve summarised some of the key concepts below as well as the FEAST study which is a landmark study discussed in both talks: Continue reading