Identifying sepsis too late
April Miller MSN, BSN, RN, CCRN

February 2014 
Volume 44  Number 2
Pages 12 - 14
  PDF Version Available!

TL, A 24-YEAR-OLD woman, is admitted to the ED on a Monday afternoon. She's been sick for 3 days with a fever, productive cough, headache, night sweats, and general malaise. Several family members had recently been treated for Group A streptococcal tonsillopharyngitis (strep throat).On the morning of her admission, TL's mother calls 911 when TL can't be easily aroused. On admission she doesn't appear very ill, but she's already on a course leading to septic shock. By Wednesday morning, TL will be dead. This article reviews the course of her illness, the treatment she received from admission to her death in 2010, and lessons learned from this experience.When the emergency medical responders arrive, TL is awake and gets on the stretcher with minimal assistance. She arrives at the ED with a temperature of 101[degrees] F (38.3[degrees] C), heart rate of 120, respiratory rate of 16, BP of 125/70, and Sao2 of 99% on room air. A chest X-ray reveals bilateral pneumonia.During the nursing assessment, TL is alert, and her BP and respiratory status are stable. A complete blood cell count and basic metabolic panel (BMP) show normal values except for hypokalemia (2.9 mEq/L; normal, 3.5-5.0 mEq/L) and hyponatremia (129 mEq/L; normal, 135-145 mEq/L). Specimens for blood, urine, and sputum cultures are obtained and rapid antigen detection testing (rapid strep screen) is negative. The ED physician prescribes 1 L of I.V. 0.9% sodium chloride with 40 mEq of potassium chloride to run at 125 mL/hr. TL is diagnosed with community-acquired pneumonia (CAP) and receives stat doses of I.V. ceftriaxone followed by I.V. azithromycin.Severe sepsis is the 10th leading cause of death in the United States, claiming approximately 200,000 lives each year.1,2 Mortality for severe sepsis is 30% to 50% and may be as high as 50% to 60% for septic shock.3 Fortunately, recent studies have identified some successful evidence-based practices and early goal-directed therapies shown to decrease mortality in patients

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