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