Surviving sepsis - 2015

A 28-year-old man was brought to the emergency department. He is conscious, worn out, BP 90/50, regular heart beat, sinus tachycardia 120 /min, tachypnoe 25 /min, SpO2 89 %. From the history: the patient has not been seriously ill so far, does not take any medication and denies any allergies. He has been complaining about a sore throat for a few days. The patient’s overall condition has worsened rapidly thoughout the day. He is gasping, he has a chest pain on the right side, expectorates purulent sputum and has a temperature up to 40 °C. You suspect him of being septic. Your first step is going to be
28
years
man
RR
25 /min
HR
120 /min
SpO2
89 %
BP
90/50 (63) mmHg
EKG
rythm: junctional
action: regular
frequency: 90 bpm
axis: 78°
PR: 120 ms
QRS: 67 ms
QT: 450 ms
elevation of S
Examination
Physical examination: audible bilateral breath sounds, sharpened clear alveolar breathing on the left side. Tubular breathing, crackles and weakened almost inaudible breath sounds present in the right base. The head, neck, abdomen and extremities are without any pathological findings.
Glycaemia
Gly
11,0  mmol/L
Arterial blood gas
pH
7,32
pCO2
26,25  torr
pO2
66  torr
BE
-6  mmol/l
HCO3
18  mmol/l
Complete blood count
HGB
130  g/L
HTC
0,42
Biochemical analysis
Na
150  mmol/L
K
4,3  mmol/L
Cl
110  mmol/L
Glycaemia
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Arterial blood gas
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Complete blood count
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Biochemical analysis
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