Sepsis

Low complexity — Circulation

Goals

  1. Recognise septic shock using the ABCDE method.
  2. Recognise the compensatory mechanism in the different phases/classes of shock.
  3. Recognise the symptoms (SIRS criteria/qSOFA) and ensure rapid initiation of sepsis treatment.

Anamnese

  • Name: Mr Konings
  • Age: 71 years
  • Family: Married
  • Occupation: Retired
  • Cultural: Not known

AMPLE

A: Unknown

M: Citalopram and oxybutynin

P: Depression and benign prostatic hypertrophy

L: Meal 4 hours ago

E: Showing confused behaviour

SBAR

S: Mr Konings has just been admitted to your ward due to general malaise. He still needs to be further assessed to investigate the underlying cause. At this time he is also showing confused behaviour.

B: Mr Konings is 71 years old. His history includes depression and benign prostatic hypertrophy.

A: See ABCDE

R: Please assess the patient using ABCDE and apply interventions where necessary.

Situation at the start of scenario

A: Clear, appears confused.

B: RR 23 breaths/min, symmetrical thoracic excursions, mildly increased work of breathing, using accessory breathing muscles, normal jugular veins, normal breath sounds over all lung fields, saturation 96%.

C: Pale colour, flushed cheeks, CRT 3 sec, HR 94 bpm regular, weak regular pulse, peripherally cold and clammy, BP 105/52 mmHg.

D: Voice on AVPU due to confusion, glucose 7.2, pupils PEARL.

E: Temp 38.6°C, pale skin, flushed cheeks, mottling on the knees. No oedema in legs. Urine output: spontaneous 250 ml 4 hours ago.

Situation at the end of scenario

A: Clear, appears confused.

B: RR 28 breaths/min, symmetrical thoracic excursions, increasingly increased work of breathing, using accessory breathing muscles, normal jugular veins, normal breath sounds over all lung fields, saturation 89%.

C: Pale colour, flushed cheeks, CRT 4.5 sec, HR 110 bpm regular, weak regular pulse, peripherally cold and clammy, BP 86/39 mmHg.

D: Voice on AVPU due to confusion, glucose 7.6, pupils PEARL.

E: Temp 39.2°C, pale skin, flushed cheeks, mottling on the knees. No oedema in legs.

Recommendations

  • Administer antibiotics