Sepsis

Mid 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 de Groot
  • Age: 69 years
  • Family: Married
  • Occupation: Retired
  • Cultural: Not known

AMPLE

A: Unknown

M: None

P: TIA and benign prostatic hypertrophy

L: Meal 2 hours ago

E: Showing confused behaviour

SBAR

S: Mr de Groot is admitted to your ward. Your colleague asks you to check on him because he appears confused. Mr de Groot is a 69-year-old man admitted for a hip fracture for which he received a hip prosthesis 4 days ago.

B: Mr de Groot is 69 years old. His history includes a TIA 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 22 breaths/min, symmetrical thoracic excursions, increased work of breathing, using accessory breathing muscles, normal jugular veins, normal breath sounds over all lung fields, saturation 93%.

C: Pale colour, flushed cheeks, CRT 3 sec, HR 115 bpm regular, weak regular pulse, peripherally cold and clammy, BP 92/49 mmHg.

D: Voice on AVPU due to confusion, glucose 7.4, pupils PEARL.

E: Temp 38.9°C, pale skin, flushed cheeks, mottling on the knees. No oedema in legs. Urine output: spontaneous 200 ml 5 hours ago.

Situation at the end of scenario

A: Clear, appears confused.

B: RR 31 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 86%.

C: Pale colour, flushed cheeks, CRT 4.5 sec, HR 136 bpm regular, weak regular pulse, peripherally cold and clammy, BP 74/34 mmHg.

D: Voice on AVPU due to confusion, glucose 9.6, pupils PEARL.

E: Temp 39.8°C, pale skin, flushed cheeks, mottling on the knees. No oedema in legs.

Recommendations

  • Administer antibiotics