Sepsis, case based learning, nurse, midwife, paramedic, hospital, antibiotics, emergency medical condition, infection, methicillin-resistant variant, vancomycin-resistant enterococci, virus, parasite, hemodynamic pattern, low cardiac pressures, pathogen, acute management
A 34-year-old nursery schoolteacher at 34 weeks' gestation contacted her community midwife complaining of a sore throat, feeling shivery and achy skin to 'flu-like' symptoms. She also reported nausea, vomiting, abdominal pain and generally feeling unwell. The midwife arranged for Fiona to be transported via ambulance to be assessed and reviewed at the local consultant-led maternity unit. Fiona's vital signs assessed by the midwife and paramedics prior to her admission to hospital were:
- Pulse 90 bpm, BP 100/60, Respiratory rate 16 breaths per min, Temperature 35°C.
- No urine specimen was obtained for urinalysis as she was unable to void.
[...] Cultures are essential before starting antibiotics, though blood cultures may not always be positive. Chest X-rays can reveal pneumonia or acute respiratory distress syndrome, and CT scans can help identify abscesses, bowel perforation, or ischemia (Fulton II, Zubair and Taghavi, 2023; Mahapatra and Heffner, 2020). The treatment of sepsis requires a prompt and systematic approach to improve outcomes and reduce the high mortality. In cases of sepsis wherein hemodynamic instability is feared, immediate action is essential. The administration of oxygen therapy is often the first step in alleviating hypoxia. [...]
[...] coli and Pseudomonas aeruginosa being the most common. Gram-positive bacteria such as Staphylococcus aureus, including methicillin-resistant variant (MRSA) and vancomycin-resistant enterococci are known for their role in sepsis and their resistance to treatments (Bullock and Benham, 2023). Viruses and parasites are less common causes of sepsis; they are identified in a small percentage of cases. The management of sepsis is further complicated when it involves drug-resistant pathogens since they are more challenging to treat. Preventative measures are critical in the treatment of sepsis, including advocating for vaccinations and improving sanitation practices. [...]
[...] Sepsis is a severe medical condition triggered by an overactive response to infection, threatening the body's organs and tissues. It typically stems from a bacterial attack but can also result from other pathogens like viruses, fungi, and parasites. At the core of sepsis is a dysregulated immune reaction. When an invading pathogen is detected, the body's immune system starts to defend it. If the response becomes excessive, as in sepsis, it causes inflammation, leading to blood clots, restricted blood flow, and potential organ damage. The risk of developing sepsis is increased in individuals with specific factors. [...]
[...] Elevated blood glucose levels exceeding 120 mg/dL can indicate a stress response to infection. Leukocyte counts are also informative; leucocytosis (count exceeding 12,000/mm3) or leukopenia (count below 4,000/mm3), along with an increased proportion of immature white blood cells (bandemia over signal an immune response to sepsis (Mahapatra and Heffner, 2020). Inflammatory markers such as C-reactive protein or procalcitonin are measured, with abnormal values suggesting an inflammatory process. Mixed venous saturation over or a PaO2:FiO2 ratio below 300, may signify compromised oxygen delivery or utilization. [...]
[...] and Dhamoon, A. S. (2019) Sepsis: The evolution in definition, pathophysiology, and management, SAGE Open Medicine. Mahapatra, S. and Heffner, A. C. (2020) Septic Shock (Sepsis), StatPearls. Polat, G., Ugan, R. A., Cadirci, E. and Halici, Z. (2017) Sepsis and Septic Shock: Current Treatment Strategies and New Approaches, The Eurasian Journal of Medicine, 49(1). [...]
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