A 74 year old male patient presents to the Emergency Department acutely unwell. He lives in a residential home and usually requires minimal care, however he has been found confused and unwell this morning.

He is currently disorientated and unable to provide any history, his carers who are with him report this is new. The patient currently denies any pain, but has a coarse cough. He reports no other symptoms. His has a background of previous MI, hypertension and type II diabetes mellitus. His current medications are: Amlodipine, ISMN and Metformin. He has no drug allergies. He does not currently smoke, but gave up 20 years ago. He is a non-drinker.

On Examination

  • Obs: Temperature: 39.1, HR 128, BP 74/56, RR 20, SpO2 – 87% On Air

  • CVS: Nil remarkable bar observations

  • Respiratory: Poor air entry on right hand side with coarse right sided crepitations.

  • Abdominal: Tender in supra-pubic region with no guarding or peritonism. Otherwise normal

  • Neurological: GCS 14, pupils equal and responsive to light, nil focal neurological deficit.

  • Bloods show an initial WCC of 18.6.

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

  1. What are your differential diagnoses and why?
  2. How would you further assess this man and give details of the steps you would take?
  3. What features would make you consider a diagnosis of Sepsis?
  4. What is Red Flag Sepsis?
  5. What are the markers of end organ dysfunction?
  6. How would you manage this patient in the Emergency Department?
  7. How would you assess where this patient should be best managed when he leaves the Emergency Department?

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