Toxic shock syndrom
You are a young anesthetist on you intensive care rotation at the ER of a tertiary hospital. You should take care of a 32 years old woman enter, that is complaining of feeling unwell, nausea, fever, diarrhea for, itchy eyes and myalgia, which started two days ago. Her speech is not coherent and she appears drowsy and confused, she is sweating. The nurse puts on the ECG and saturation probe and measure her blood pressure and secure the IV access.
During history-taking, she states that she is allergic to penicillin, and denies pregnancy, since her last menstrual period was a week ago. She reports to have bad smelling discharge from the vagina since then. The woman suddenly becomes unconscious and is no longer responding to your verbal or painful stimuli. What would your first step look like?
As the patient displays the signs of septic shock, your first step would be to obtain haemocultures, further you follow the Sepsis Survival Campaign guidelines, which prioritises the identification of the causative agent.
As the patient is unconscious, you follow the current European Resuscitation Council Guidelines. Your first step, therefore, is to start with CPR via 30 chest compressions, followed by 2 rescue breaths. I ask for the adrenaline (1:10 000) to be prepared and the defibrillator to be ready to deliver a shock if shockable rhythm is detected.
You should call for help and following the ABCDE approach, your first step would be securing the airways (done via tracheal intubation because you are trained to do so, using Rapid Sequence Induction, you decided to use ketamine, recuronium, sufentanil and midazolam) and continue with the therapy according to the current Surviving Sepsis guidelines.
As the patient displays the signs of the septic shock, it is of the utmost important to administer the broad- spectrum antibiotics as soon as possible- you make this your priority and administer IV meropenem 1g every 8hours and IV vancomycin 15mg/kg every 8 hours.