A 79-year-old found less responsive in his bed at a residential home.
— PMH: DM, BPH, CVA, Meds / Metformin, Tamsulosin, Aspirin, Simvastatin

Observations

A – Patent

B – Resp Rate 25, Sats 94% (21%)

C – HR 120, BP 91/65

D – E4 V4 M5 (13)

E – Temp 38.9°C

Clinical Findings

  • Dry mucous membranes

  • Clear chest

  • Soft abdomen with suprapubic tenderness…


Why We Simulated

There is an increasing focus on the identification and management of sepsis, and when you consider the mortality and morbidity it is easy to understand why it is focused on.

We've run previous simulations of this scenario, but as many of you will be aware there have been some recent updates to sepsis guidelines. Rather than redoing the good work of others we will point you in the direction of the following:

  1. RCEM FOAMed on the NICE SEPSIS Guidelines

  2. The NICE Guidelines themselves

The take home message as ever has to be that if you don't think sepsis you won't spot it, and if we don't treat it in a timely manner then the outcomes for our patients are worse.

The screening tool we are using is covered in the embedded video. It is important we identify those patients with Red Flag Sepsis in order to escalate their care appropriately.

We'd also like to remind you to think about the SEPSIS Mimics too, we don't always have all the answers in the ED and it can be of value to consider and treat more than one pathology until further results from investigations become available.

Learning Points

  • Consider identifying a team leader for a hands off role.

  • Formal allocation of job roles can make a team function more efficiently. 

  • Remember to utilise the management tools and guidelines available in the ED.

Positive Feedback

  • Identified red flag sepsis and gave appropriate interventions promptly.

  • Good communication. Use of summary and use of a clear 'this patient is very unwell, their EWS is 8.

  • Recognised need for senior support and decision making regarding escalation.


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