Assessment: Patient opens eyes to name. Weak grip. Radial pulses +1, Pedal pulses per Doppler.
VS: HR 125, RR 16, BP 80/40, T 102, SaO2 88%
Assessment: Patient opens eyes to name. Weak grip. Radial pulses +1, Pedal pulses per Doppler.
BS continue to be absent. Lung sounds with coarse crackles bilaterally. Blood glucose 400. Urine output 10 ml in last hour
See lab results and ABG results
Doctor’s Orders:
Begin septic shock bundle
Infuse Potassium 10meq in 100 ml NS over 1 hour now
Give NS bolus of 500ml over 30 minutes
Begin Ciprofloxacin 400mg Q 8 hours IV piggyback
Place Pulmonary artery catheter (PAC)
Place on 100% venti mask
Call with hemodynamics when PAC inserted
Place NG tube
PAC placed, hemodynamics:
CO 3
CVP 10
SVR 10,000
SvO2 75%
VS: HR 120, RR 12, BP 75/40, T 102, SaO2 88%
- Analyze AG results.
- Identify abnormal lab values.
- In the above information, identify four parts of information of which are critical to notify doctor.
- Define CO, CVP, SVR, SVO2, also give normal values.
- Looking at the sepsis shock bundle, address each point. What would you do to achieve each area?
ABG Values
pH | 7.30 |
PaCO2 |
49 |
Bicarbonate
|
18 |
PaO2
|
70 |
SaO2 | 90% |
Complete Blood Count Lab Values
Lab | Result |
WBC | 27,000 |
RBC | 5 |
Hemoglobin | 10 |
Hematocrit | 29 |
Platelets | 250 |
APTT | |
PT | |
INR |
Electrolytes Lab Values
Lab | Result |
Sodium | 140 |
Potassium | 2.7 |
Chloride | 101 |
BUN | 37 |
Creatinine | 1.9 |
Glucose | 300 |
CO2 | 33 |
Magnesium | 1.4 |
Ionized Calcium | |
Lactic Acid | 10 |
Septic Shock Bundle
- Maintain MAP >65 mm Hg
- Begin vasopressors for hypotension that does not respond to initial fluid resuscitation
- If patient remains hypotensive despite volume resuscitation or initial lactate >4
- Maintain CVP 8-12 (12-15 if mechanically ventilated)
- Maintain SvO2 60-80%