The sepsis patient not improving after IV fluids and resuscitation: What should be considered? How can we improve?

You are in the midst of caring for a 62 year-old male who is tachycardic with HR 120, BP 88/42, T 101.2 oF, RR 26, and SpO2 98%. He was brought in by EMS for fever and myalgias, and with one look at his vital signs, he triggered the protocol for SIRS.

Your initial exam showed similar vital signs, with dry mucous membranes but otherwise normal HEENT exam, clear lungs, normal mental status, nontender abdomen, normal skin and genitourinary exams, and normal extremities/back. Due to his vital signs and SIRS criteria, you were concerned and ordered CBC, RFP, LFT, lactate, blood cultures, urinalysis/culture, and chest xray. You started 1 L NS, and his VS did not improve.

Recognizing and Preventing Acute Decompensation in the ED

“What Happened?” Recognizing and Preventing Acute Decompensation in the ED Authors:  Michael C. Perry, MD (EM Resident Physician/University of Texas at Austin Dell School of Medicine) and Janna Welch, MD (Assistant Residency Director, University of Texas at Austin Dell School of Medicine) // Edited by: Jennifer Robertson, MD and Alex Koyfman, MD (@EMHighAK) The emergency […]

intern-report

Intern Report Collection, Vol. 8

To kick off your weekend reading pleasure, here’s another batch of our monthly excellent write-ups from the EM interns at UT Southwestern (@DallasEMed) and Icahn School of Medicine at Mount Sinai courtesy of Alex Koyfman (@EMHighAK) and Stephen Alerhand (@SAlerhand) . Our ongoing intern report series is the product of first-year residents exploring clinical questions they have found to be particularly intriguing, with an intended audience of med students & junior residents. Enjoy!

Emergency Medicine Education