Patient priorities for treatment and care
Where the assessment results in the suspicion of sepsis, treatment and care needs to be prioritised.
Blood results currently indicate infection is occurring as CRP level and white cell count are increased. The physiological effects of sepsis will be seen in the blood results, e.g. haemoglobin level falls and serum lactate levels rise as the body starts to use anaerobic metabolism.
Serum lactate is the main blood test that indicates the level of severity in sepsis. High (red) risk sepsis is diagnosed when the lactate level is above 2 mmol/L. A moderately high level of 1.8 mmol/L means this test will need repeating. Where the serum lactate level is high, a further intravenous fluid bolus needs to be started.
Tazocin was given in the ED as a result of the assumed infection which needs to be reviewed with the microbiology results, e.g. blood cultures. Depending on the potential cause, antimicrobial medication may need to be given quickly, but should be regularly reviewed to ensure SMART use of targeted antimicrobial medications. A full patient examination chasing results of tests completed and further investigations to establish the cause of the sepsis should continue (e.g. swabs, specimens, x-ray).
Further assessment of the patient's level of hydration needs to be undertaken. Patients with sepsis easily become dehydrated as fluid moves out of the blood stream into the interstitial space as the infections cause capillaries to become leaky. Dehydration often leads to one of the initial signs - a reduced urine output for the patient.
It is vital to monitor the respiratory and cardiovascular stability of the patient. As haemoglobin is affected in sepsis, the oxygen carrying capacity of the red blood cells falls. Consequently, respiratory and heart rates rise. The BP will fall usually in response to the drop in blood circulating volume. Lowered oxygen levels will require oxygen therapy to be titrated to maintain SaO2 94-98% or 88-92% in known COPD.
If the risk of sepsis is increasing, more invasive monitoring and cardiovascular support using inotropes and vasopressors may be required. Early escalation to appropriately experienced healthcare professionals (e.g. Registrar, consultant, or Critical Care team) is essential.