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| * A 70-year-old man |
| | #178551 |
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presents to the emergency department with a 2-day history of fever, chills, cough, and right-sided pleuritic chest pain. On the day of admission, the patient’s family noted that he was more lethargic and dizzy and was falling frequently. The patient’s vital signs are: temperature, 101.5°F; heart rate, 120 bpm; respiratory rate, 30 breaths/min; blood pressure, 70/35 mm Hg; and oxygen saturation as measured by pulse oximetry, 80% without oxygen supplementation. A chest radiograph shows a right lower lobe infiltrate.
This patient’s condition can best be defined as which of the following?
a Multi-organ dysfunction syndrome (MODS)
b Sepsis
c Septic shock
d Severe sepsis
e Systemic inflammatory response syndrome (SIRS)
What is the first step in the initial management of this patient?
a Antibiotic therapy
b ß-Blocker therapy to control heart rate
c Intravenous (IV) fluid resuscitation
d Supplemental oxygen and airway management
e Vasopressor therapy with dopamine
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| * Re:A 70-year-old man |
| #740453 |
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d.Severe sepsis. The patient fulfills criteria for severe sepsis, defined as sepsis with evidence of organ dysfunction, hypoperfusion, or hypotension. SIRS is defined as an inflammatory response to insult manifested by 2 of the following: temperature greater than 38°C (100.4°F) or less than 36°C (96.8°F), heart rate greater than 90 bpm, respiratory rate greater than 20 breaths/min, and white blood cell count greater that 12 × 103/µL, less than 4 × 103/µL, or 10% bands. A diagnosis of sepsis is given if infection is present in addition to meeting criteria for SIRS. Septic shock includes sepsis-induced hypotension (despite fluid resuscitation) along with evidence of hypoperfusion. MODS is the presence of altered organ function such that hemostasis cannot be maintained without intervention.1 This patient’s lack of fluid resuscitation classifies him as having severe sepsis rather than septic shock.
d.Supplemental oxygen and airway management. The initial evaluation of any critically ill patient in shock should include assessing and establishing an airway, evaluating breathing (which includes consideration of mechanical ventilator support), and restoring adequate circulation.2 Adequate oxygenation should be ensured with a goal of achieving an arterial oxygen saturation of 90% or greater |
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