- Joined
- Dec 18, 2003
- Messages
- 623
- Reaction score
- 7
Saw a 60 yo woman with metastatic breast Ca presenting with AMS, walking/talking/mentating/well 24 hrs ago. Tachycardic/hypotensive. I started my workup and was horrified to find that every test I sent came back positive.
Accucheck 50 -> 1 amp D50
CXR - PNA
UA - UTI
Labs included K 2.5, Lactate 4.1, Troponin 1.5. Pt was not neutropenic.
CT chest - multilobar PE and PNA
Hit her with 4 liters IVF (only peed on liter 4), Vanc/Zosyn/Avelox, heparin, Dexa for her presumed adrenal insufficiency. Called medicine and they tried to convince family to make her comfort care. We settled on DNR/DNI and no escalation of care.
By the time she went up she had a normal HR, BP, lactate normal (didn't do sepsis protocol bc family didn't want central line, and I agree -> I hate doing lines just to measure CVP/SVO2) and two days later she's feeling well.
Sure, I only gave her a month or two at most, but I think it's better than rotting away from pneumonia/UTI and multiple PEs.
Rivers showed us we can make a difference in sepsis. Don't write'em off.
Accucheck 50 -> 1 amp D50
CXR - PNA
UA - UTI
Labs included K 2.5, Lactate 4.1, Troponin 1.5. Pt was not neutropenic.
CT chest - multilobar PE and PNA
Hit her with 4 liters IVF (only peed on liter 4), Vanc/Zosyn/Avelox, heparin, Dexa for her presumed adrenal insufficiency. Called medicine and they tried to convince family to make her comfort care. We settled on DNR/DNI and no escalation of care.
By the time she went up she had a normal HR, BP, lactate normal (didn't do sepsis protocol bc family didn't want central line, and I agree -> I hate doing lines just to measure CVP/SVO2) and two days later she's feeling well.
Sure, I only gave her a month or two at most, but I think it's better than rotting away from pneumonia/UTI and multiple PEs.
Rivers showed us we can make a difference in sepsis. Don't write'em off.
