I would like some opinions about a clinical situation.
At the community hospital I work at, we do a sepsis screening w/ each assessment and anytime the patient's temperature is greater or equal to 100.3. If the patient screens positive then we have to call the doctor and ask if they want to initiate the "sepsis bundle" of orders. These orders consist of fluid bolus, lactate level, blood cultures and initiation of empiric antibiotics. We are also supposed to initiate a rapid response.
So, I had a young patient who had a lap appy after a perforation.
Based on my limited knowledge of abx treatment, cefepime was appropriate as a first-line agent in those with abdominal infections from the intestines. Vanc is also an appropriate treatment if it appeared that cefepime wasn't working. His fluids were going at an appropriate continuous rate also in the setting of infection. The only parts of the sepsis bundle that were missing is bolus, cultures, and lactate, all of which are relatively harmless to the patient.
I would have been more worried regarding his respiration rate, which is usually the first thing to become abnormal with sepsis. With him, it would obviously be the second thing because he already was febrile. Granted, he just woke up, and his inspiratory effort may have been poor secondary to his abdominal pain. However, you said his SpO2 via pulse oximetry was only 85%. That worries me even more. There is a "shunting theory" in sepsis, which is a compensation to maintain SBP. I found a great abstract that is succinct in describing this.
Part of the problem is that Doctor and hospitals are not getting compensated by Insurance companies, Medicare or Medicaid are not getting paid for what 3 party payers deem unnecessary tests. If the tests come back negative 3rd party reviewers can deny payment. So doctors who want to get paid are more cautious about ordering tests. I actually had a Dr. Tell me this.
hppy
Very interesting. Thanks so much for this. I wish I could talk to the doctors more to ask them their rationales for doing things but I am on night shift. Also, most of the doctors aren't too open to taking the time to talk about stuff. They are kind of old school.
annie.rn
546 Posts
The respiratory status worried me, for sure. Thanks for info. and the links. I will def. add them to my reading list!