A 67yr old male with multiple comorbidities is brought by ambulance with a 3-day history of diffuse abdominal pain. The history is vague and the differential of his symptoms remains very broad. He develops significantly worsening pain and hypotension and becomes obtunded. As the patient’s condition deteriorates, the team must initiate management of abdominal pain plus shock and support the hemodynamics with vasopressors/inotropes. The team will need to intubate to facilitate advanced imaging and definitive care.
Denise is a 59-year-old female who presents with a 7-day history of urinary symptoms, fever, and left flank pain. She has a history of STEMI 5 years ago with chronic left-sided heart failure. She becomes unstable in the ER, requiring judicious fluid resuscitation, vasopressors, and empiric antibiotic treatment. The team leader needs to consider the history and arrange renal imaging to discover the severe sepsis is secondary to an infected ureteric calculus. From there, emergent urologic consultation and admission to hospital is warranted.
This case involves the approach to severe sepsis, more specifically acute cholangitis. If treated aggressively (IV fluids, early broad spectrum antibiotics and source control) the patient will stabilize. If not, the patient will deteriorate into a PEA arrest.
In this case, the patient has been admitted for pneumonia and treated with the usual antibiotics. However, the team has not yet recognized that the causative bacteria is resistant to this antibiotic. The pneumonia has progressed and the team must manage the patient's respiratory distress and sepsis. The patient requires a change in antibiotics, non-invasive ventilatory support and IV fluid resuscitation.
A 3-day-old term male infant is brought to the ED by EMS after being seen at their Family Physician’s office with a low temperature (33.1oC). The child has been feeding poorly for about 12 hours, and has vomited twice. He is lethargic on examination and poorly perfused with intermittent apneas lasting ~ 20 seconds. He requires immediate fluid resuscitation and broad-spectrum antibiotics. His perfusion will improve after IVF boluses, however the apneas will persist and necessitate intubation.
A 4 year-old girl is brought to the ED because she is “not herself.” She has had 3 days of fever and cough and is previously healthy. She looks toxic on arrival with delayed capillary refill, a glazed stare, tachypnea and tachycardia. The team will be unable to obtain IV access and will need to insert an IO. Once they have access, they will need to resuscitate by pushing fluids. If they do not, the patient’s BP will drop. If a cap sugar is not checked, the patient will seize. The patient will remain listless after fluid resuscitation and will require intubation.
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.