Clinical Cases in Paramedicine. Группа авторов
Respiratory sepsis
| Information type | Data |
| Time of origin | 09:15 |
| Time of dispatch | 09:30 |
| On‐scene time | 09:43 |
| Day of the week | Sunday |
| Nearest hospital | 20 minutes |
| Nearest backup | 40 minutes |
| Patient details | Name: Nicholas Beaumont DOB: 01/01/1947 |
CASE
You have been called to a residential address for a 73‐year‐old male complaining of weakness and shortness of breath.
Pre‐arrival information
Patient is conscious and breathing. Upstairs in bed.
Windscreen report
The scene is safe. You are met at the door by the patient’s wife.
Entering the location
The wife tells you her husband has had a productive cough for 3 days and is now unable to get out of bed.
On arrival with the patient
The patient is lying in bed and appears lethargic.
Patient assessment triangle
General appearance
Alert but lethargic.
Circulation to the skin
Flushed, warm to touch and clammy.
Work of breathing
Increased work of breathing.
SYSTEMATIC APPROACH
Danger
None at this time.
Response
Alert on the AVPU scale.
Airway
Clear.
Breathing
RR: 34. Rapid. Mild accessory muscle use. Right basal crackles on auscultation.
Circulation
HR: 130. Radial palpable but weak – regular. Capillary refill time 3 seconds.
Disability
Pupils equal and reactive to light (PEARL).
Exposure
The patient is in his own bed and the ambient temperature is warm.
Vital signs
RR: 34 bpm
HR: 130 bpm
BP: 108/54 mmHg
SpO2: 87%
Blood glucose: 8.3 mmol/L
Temperature: 38.4 °C
GCS: 15/15
4 lead ECG: sinus tachycardia
Allergies: nil
TASK
Look through the information provided in this case study and highlight all of the information that might concern you as a paramedic.
Case Progression
You administer high‐flow oxygen titrated to maintain an SpO2 of 94–98%. Fluid is not indicated at this time and your local guidelines do not allow for the administration of prehospital antibiotics. You commence rapid transport to the Emergency Department with a sepsis pre‐alert.
Patient assessment triangle
General appearance
Alert.
Circulation to the skin
Flushed.
Work of breathing
Increased work of breathing.
SYSTEMATIC APPROACH
Danger
None at this time.
Response
Alert.
Airway
Clear.
Breathing
RR: 30. Right basal crackles.
Circulation
HR: 126. Weak radial. Capillary refill time 3 seconds.
Disability
Moving all four limbs.
Exposure
Normal temperature in the ambulance. Patient covered with sheet not blanket to assist with ambient cooling.
Vital signs
RR: 30 bpm
HR: 126 bpm
BP: 100/58 mmHg
SpO2: 90%
Blood glucose: not repeated
Temperature: 38.3 °C
GCS: 15/15
4 lead ECG: sinus tachycardia
1 What is sepsis? ‘Sepsis is characterised by a life‐threatening organ dysfunction due to a dysregulated host response to infection’ (UKST, 2019, p. 14).
2 Outline the pathophysiology of sepsis. Sepsis is when the body’s natural inflammatory immune response to a localised infection becomes systemic, setting off a chain of physiological responses that quickly become life‐threatening. It is an exaggerated response involving both the complement system (immune response) and the coagulation cascades.The body tries to keep up with the increased demand for oxygen by raising the respiratory rate (RR) to increase the level of oxygen in the blood and to