Suriving sepsis - the first hour bundle

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  • Suriving sepsis - the first hour bundle
A 25yo trauma patient was hospitalized at the ward following a car crash. His injuries involve a fractured pelvis, humerus, four ribs and a pneumothorax, which was drained intermittently. Drain was extracted three days ago, control chest X-ray without pneumothorax. Humeral and pelvic osteosynthesis was performed, rib fractures were treated conservatively. During patient's post-operational recovery, there were no bleeding-related complications for seven days, hemoglobin and leukocytes were rising. Now the patient is somnolent, worn out and dyspneic. To raise his oxygenation you administer oxygen via a face mask. A likely diagnosis will be:

Sepsis according to qSOFA score.

Correct answer

Patient is suspected of having sepsis and fullfils qSOFA criteria - systolic pressure <100 mmHg, BF >= 22 and impaired conciousness. Intensive care will be required in order for the treatment to reach optimal results. Evaluation of qSOFA or quick sepsis related organ failure assessment aims at selecting patients with suspected infection who possess higher chances of dying or prolonged stay at the ICU. The three criteria mentioned above are evaluated on a scale from 0 to 3 points, where scores of 2 and higher indicate higher risks of negative results of the treatment.


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To determine the final diagnosis, you send the patient for a chest CT scan first, which will be available in 8 hours due to planned outage.

Wrong answer

A chest X-ray and/or an ultrasound can both be performed at first, without the need of transporting an unstable patient for a CT scan.


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Life-threatening bleeding when haemothorax is suspected.

Wrong answer

Symptoms such as fever, expulsion of mucus and the auscultation findings point to a different diagnosis.


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Pneumothorax after the removal of chest drainage.

Wrong answer

Pneumothorax may happen following the removal of a thoracic drain. A control X-ray was performed where pneumothorax was not present. However, symptoms like fever, expulsion of mucus and the auscultation findings suggest a different diagnosis.


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qSOFA = Sepsis related organ failure assessment
Sinus tachycardia >100/min, eupnoe 16-18/min.×
 
RR

26 bpm

HR

128 bpm

SpO2

89 %

BP

86/50 mmHg

ECG

regular pace

Examination:
Patient is somnolent, short of breath, dypsnoic, fever 38,9°C, shivers and coughing up a green-yellow dense sputum.
On auscultation, breathing is weakened on the right side, in the lower and middle lung field, diffuse bilaterally. Cardiac rythm regular, sounds without murmur, tachycardia.
Head, neck, abdomen, limbs without pathological finding.

Gly

results

ABG

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CBC

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biochemistry

results