sepsis 6 presentation

8/11/2019 Sepsis 6 presentation

1/16

Sepsis 6 ExamplesDr Andrew Robertson


2/16

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


3/16

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.


4/16

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.


5/16

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).


6/16

Sepsis 6


7/16

Sepsis 6

1650

O2

BCs

Abx (amox and metro, gent withheld forU+E)

Colloid

Lactate + ABG Hourly UO (and subsequently

catheterised)

1750


8/16

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.


9/16

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


10/16

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


11/16

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...


12/16

Sepsis 6

Always if SIRS>2 + Pyrexia +Suspicion

To consider:

History & Examination!

?Sepsis ?Alternative

Urine/ sputum cultures, imaging,

bloods....


13/16

Sepsis 6

Sepsis 6 sticker ?Y.O.


14/16

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


15/16


16/16

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

sepsis 6 presentation

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