Intra-abdominal Sepsis

This case was written by Dr. Martin Kuuskne from McGill University. Dr. Kuuskne is a PGY5 Emergency Medicine resident and one of the editors-in-chief at EMSimCases.

Why it Matters

Although recent literature has challenged the use of protocolized care in the management of sepsis, this case highlights the key points that are crucial in early sepsis care, namely:

  • The recognition of sepsis and identifying a likely source of infection
  • The initiation of broad-spectrum antibiotics in the emergency department
  • Hemodynamic resuscitation with intravenous fluids and vasopressor therapy

Clinical Vignette 

You are working a day shift at a community hospital emergency department. You are handed a chart of a patient presenting with abdominal pain. You recognize the following vital signs: Heart rate 120, blood pressure 85/55, respiratory rate 20, and O2 Saturation 95%.

Case Summary

A 60-year-old male presents with a four-day history of abdominal pain secondary to cholangitis. The patient presents in septic shock requiring intravenous fluid resuscitation, empiric broad-spectrum antibiotics and vasopressor support and suffers a PEA arrest prior to disposition to advanced imaging or definitive management.

Download the case here: Cholangitis

ECG for case found here: 

Sinus tachycardia

(ECG source: http://cdn.lifeinthefastlane.com/wp-content/uploads/2011/12/sinus-tachycardia.jpg)

CXR for case found here: 

CXR

Ultrasound for case found here:

http://www.pocustoronto.com/wordpress/?p=264

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