Pt arrived to unit in respiratory distress, was intubated and put on CMV 80% FiO2. B/P low on arrival in 70's-80's and pt got 500ml NS bolus.
B/P remained low in 70's after bolus (boluses were given over 1 hr)
HR 130-138
Temp 40.2 C
RR maybe 16-22
0 urine out for 2 hours upon arrival (until started on pressors)
report states pt has hx of HTN, CHF, and possible UTI and PE
Pt got bolus of 500ml NS, B/P still low with MAP about 50-52.
Started another 500ml bolus but B/P remained low, medicated for temp, and started on Vaso 0.04units/minute to achieve MAP> 65.
>>>>Would you argue that Phenylephrine should have been started first?
The Vaso combined with continuous bolusing of 250ml NS per hour achieved MAPs in 65-70's and Syst B/P 90's. o2 sat stayed 97% the whole time (even with weaning Fio2 to 50%) Neo was added later to assist B/P
Pt on Heparin gtt, then determined to have definite DVT in leg. PE undetermined bc poor kidney functioning. Creat 6.3
When checking labs, lactate came back 1 something, and the ICU fellow states "pt is not septic-they don't even have an elevated lactate"
>>>>>I have not found anywhere that lactate level is a determinant of sepsis or MODS.
