[color=#1a1a1a]i'm only in nursing school, but i hope to be a critical care nurse after i graduate. some of what zaphod said makes sense to me, but some seems odd. i could be wrong, and, in fact, probably am. if i am wrong, and someone else has a definitive answer, i would love to hear it. as we all know, sepsis is an infection of the blood, and is quite severe. as we also all know, in response to infection (more specifically, the toxins released in the body due to the sepsis) the body produces cytokines which produce inflammation and aide in the immune response. cytokines, however, have some negative effects on the body, the most life-threatening, and most noticeable, of which is vasodilation. as the blood vessels dilate, the blood pressure drops, blood flow decreases to the vital organs, and the heart compensates by increasing the heart rate (causing tachycardia), and the cardiac output. eventually, the heart gets tired of compensating, and the volume of blood being pumped out (the cardiac output) drops. as the tissues receive less blood volume, they release lactic acid into the blood, and the ph begins to become acidic.
[color=#1a1a1a]i understand that, initially, the body may effectively compensate, and the co and bp may remain somewhat stable. i do not understand, however, how the patient's blood pressure could be in the 140s/100s upon presentation to the ed. this is where i am confused by the other poster who said that the elevated bp was due to the compensatory mechanism of the body. i suppose that the vessels could have constricted very tightly as the body tried to maintain its blood pressure, but i don't think the vasoconstriction would be enough to drive the pressure that high. someone correct me if i'm wrong in that assumption because i am here to learn.
[color=#1a1a1a]i agree with you that, perhaps, the fluid boluses shouldn't have been given. i did some work in the ed prior to beginning nursing school, and we usually had to bolus our sepsis patients because the pressures we saw were so ridiculously low. however, if we had a patient whose pressure was high, we did initiate several lines and prepare two or three bags of iv fluid in case we needed to rapidly bolus the patient. we tried not to bolus a patient who had a decent pressure because we didn't want to send anyone into chf or hypervolemia. we also considered getting dopamine or levophed out, labeling it, and keeping it at the bedisde just in case. also, with the bun and bnp being elevated, i am lead to believe that the patient has some degree of renal failure and chf, or some form of heart failure. the renal failure and heart failure could explain why the urine output was low, but sepsis could also explain that, as one previous poster alluded to.