Had a Pt today who had a colectomy due to intestinal volvulus, was in surgery/PACU from about 1115, 1130, to about 3, 330 pm. Got back to my floor at 3:30, BP about 106/50, pulse 115, after he'd been SBP's 115-120, pulse 80's, all through surgery and PACU - by 5:30 pm, BP at 70/40, pulse 120, and we placed him in ICU with suspicion of septic shock-
There were a couple of other issues with this Pt (1) his lungs sounded terribly rhonchi-y, his external breathing was wet-sounding and since the PACU nurse stated, "He just started having that wet breathing now in the room, his respirations were normal-sounding before, " I thought maybe he'd aspirated during transfer or when we laid him flat briefly while turning him, and so I was thinking that high pulse was maybe 2' aspiration) - also, 2) he was poorly arousable, but he'd been drowsy before surgery, and a lot of post-op Pts are poorly arousable, and he'd gotten a lot of pain meds. Really, my main concern was his wet-sounding, labored breathing, and the continued high pulse (when we could pick up on his O2 Sat, it was 99, 100, although it was difficult, because he kept trembling/twitching his arms; was difficult even to get an O2 sat on his earlobe); - and I worked for a couple of hours, assessing, debating, and calling RT and MD, working with solumedrol, CXR (normal), albuterol, atrovent, tropi (normal), tele (sinus tach, 115 - 120's), ABG (showed partially compensated metabolic acidosis, - pH 7.34 or 7.35, CO2 25, O2 99, HCO3 15 - which flummoxed me, because I kept thinking "respiratory, respiratory" not metabolic - i.e., shock, and I couldn't figure out what would be causing a metabolic acidosis - I thought maybe it was some electrolyte imbalance after abdominal surgery), before calling a rapid response team when his BP dropped.
-but my question is, have you seen septic shock develop so quickly, and so quickly after surgery?? I guess maybe the germs were already there in his bloodstream pre-op, but, still, why'd he drop out like that on me, within 2 hours? (HGB did come down from 9.6 pre-op to 8 post-op, but colostomy dressing had only mild drainage, and this Pt had had multiple transfusions during his month-long stay, and I'm not seeing a 1.6 point drop in HGB causing that kind of low BP, so I guess everyone is right about the cause being septic shock - the MD and ICU nurses kept saying "sepsis") But I didn't know it could happen so quickly! Really, I would have thought that the only type of shock that could present so quickly would be from loss of fluid/hypovolemic, not septic. (And why did his pulse only spike when he hit my floor? From 80's to 115 within 15 minutes? I still think that that rapid pulse change there may have been 2' aspiration - he couldn't have just gotten compensatory tachycardia 2' sepsis in the duration of the elevator ride.)
Appreciate your help and wisdom.