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Applied Bioscience Critical Care

Case Study: Sepsis

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Applied Bioscience Critical Care: Sepsis Case Study Semester 12, 2015

2500-3000 Words

A 62-year-old female (Jessica Simpson) with a history of type 2 diabetes mellitus and hypertension was admitted to a trauma center following a Motor vehicle accident. Examination revealed blunt thoracic and abdominal trauma and a fractured right femur. The patient was dyspneic, tachycardic, hypotensive, and her skin was pale and cool. A right-sided hemothorax was managed by chest tube insertion. Imaging studies, along with exploratory surgery, revealed extensive trauma and bleeding within the abdominal cavity. Surgical management of the abdominal hemorrhage and the fractured femur resulted in significant improvement in vital signs, and the patient was moved to the ICU.
Four days later, the patient became febrile (39.8) and her WBC count was elevated 10,000. Sepsis was immediately suspected, broad-spectrum IV antibiotic therapy was initiated, and blood cultures were obtained. During the following 24-48 hours, the patient experienced increasing respiratory distress (28 RR) and hypotension 90/40 BP. Urine output decreased and the serum creatinine and blood urea nitrogen were elevated. Deteriorating blood gases necessitated intubation and mechanical ventilation. The patient was determined to be in severe sepsis leading towards septic shock.

Clinical findings: Vital Signs on Fourth Day

Temperature: 39.8, Bp 90/40, RR 28, HR 136, patient became confused and showed signs of abdominal distension and rebound tenderness.

1. Define: Sepsis, Severe Sepsis and Septic shock (Research Recent literature, definitions only max 200 words for all three definitions)

2. Evaluate SIRS in relation to the above patient and what “criteria” does she have to indicate SIRS (Recent Journal Articles only, refer back to Jessica)

3. Identify the causative organisms commonly associated with sepsis? What could be the leading organism for Jessica?

4. Examine and evaluate the following six topics in relation to the evidenced-based care requirements for a patient with septic shock (Journal Articles and recent texts only). Briefly discuss in your answer

• Antibiotics Therapy – Discuss IV antibiotics commonly used in Septic Patients with Gram Positive infections.

• IV Fluids – Including Rationale for Colloids/Crystalloids

• Blood Glucose control

• Hemodynamic Monitoring – CVP/Arterial MAP

• Ventilation management – Invasive Ventilation

• Stress Ulcer Prophylaxis

5. Multi Organ Dysfunction Syndrome (MODS) is commonly associated with sepsis. Briefly explain the changes to the following systems when a patient is in MODS.

• Endocrine

• Respiratory

• Gastrointestinal

• Renal

• Cardiovascular

• Hematologic

6. Explain Vasopressors (Noradrenaline and Dobutamine) in relation to Jessica. Briefly explain what these drugs do, how they are administered and why Jessica has been prescribed them.

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