Antibiotic initiation/effectiveness - page 2

by 1fastRN 1,893 Views | 16 Comments

Hey guys, I lost my first patient the other night....a patient that was actually my assignment. Ive had other patients that were in cardiac arrest upon arrival but I dont consider that the same. It was an older (but walkie... Read More


  1. 0
    Great thread! Especially the info about abx while the patient is circling the drain.

    Here's my question: Can ARDS itself cause flash pulmonary edema (i.e. not in the setting of CHF)? Or will the onset be more gradual?
  2. 2
    Yes it can cause flash pulmonary edema that may not be responsive to diuretics at all because of the massive inflammatory response from the overwhelming infection.
    ktliz and Anoetos like this.
  3. 1
    Also, 1fastRN, look at it this way: if abx were a "life saving" med, they would be at our fingertips and not have to be tubed from pharmacy! That's why we have intubation and hemodynamic drugs at our fingertips. ABCs first--the rest can wait.
    Sugarcoma likes this.
  4. 0
    Great words of wisdom. Thanks guys!
  5. 0
    There's no way to have known this was coming. Sepsis can "gallop" on an elderly patient, but it doesn't usually. There doesn't seem to have been any indication that she was moribund.

    She came from the ED with abx started, right? I think that's pretty much procedure anywhere. I'm currently in the ED (having transferred from medical step-down) and we start abx on all elderly pts of whom we suspect UTI/Urosepsis/Pneumonia, also waiting 0:45 for a reaction. Additionally, with pna we're now doing blood cultures first. No pt gets abx without cx being drawn

    The point above about flash edema is also well-made.

    Other questions: I am assuming that since she clearly went into shock her BP was tanking, did you bolus her fluids (if she could tolerate them)? Did you start pressors upon adequate hydration (this is posted in critical care so I am assuming you can start pressors where you work, I could be wrong). This may be something they would have done once they got her to the unit, I don't know how your facility works.

    All of this said, we need better education in the elderly population about the dangers of UTIs.
  6. 0
    What was her lactic acid?
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    You reach a point of no return with sepsis. You can do everything humanly possible and you are just not going to save these people. I am often shocked at how sick some of these people are when they first present, and at how long they can maintain their BP, especially the elderly. The delay in ABX did not cause her death and nebs would not have fixed pulmonary edema.

    The ccm link ESME provided has an excellent tutorial on sepsis. Love that website, which incidentally, I also discovered via an ESME link. Esme12
    Esme12 likes this.


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