A 75-year-old man presents with a 4-day history of a productive cough and is now feeling quite short of breath. He is usually fairly fit and totally independent, living alone with no carers.

Observations

A – RR 21

B – Sats 94%

C – HR 93

D – BP 110/86 (usually 140/90)

E – Temperature 38°C

Clinical Findings

  • Hypertension

  • Currently on Ramipril

  • NKDA

Why Did We Sim?

This simulation was designed to highlight the subtleties of both recognising sepsis and it’s management (according to UHL sepsis guidance). The patient has presented with a productive cough and mildly deranged observations. He is scoring for sepsis, but not red flag at this stage.

The bloods are done and VBG shows a lactate of 3.6. Antibiotics and fluids are commenced. A CXR is performed which shows a right-basal consolidation. After the patient has received treatment and the fluid bolus has gone through, a repeat VBG is performed, which shows the lactate has dropped to 2.6. At this stage the BP drops to 90/60.

According to the UHL guidelines, if the lactate has not dropped below 2 following adequate fluid resuscitation, Critical Care should be involved.

SOS Sepsis 6 infographic.jpg

Learning Outcomes

  1. Always remember to take a full social history from the patient. If at a later time you need to refer on, especially to critical care this will be vital information.
  2. If the patient does not have any history of heart failure, give a full volume of fluid resuscitation, not just one bag.
  3. Think ahead past informing your senior, if they are not immediately available you need to have a plan.
  4. Know your sepsis guideline and local escalation policy.

Positive Feedback

  • Good use of team members, with clear delegation and instructions.

  • Good history of presenting complaint.

  • Sepsis recognised early and antibiotics administered very quickly, well within the hour target.

Edit & Peer review by Damian Roland & Darren Whitelaw

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