Sepsis? Or, Is It Not Sepsis? That Is The Question

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Infections disease can be a difficult evaluation. If a patient presents with an infection like complaint, we have to focus on the complaint and the degree of risk. The extremes of age are the most difficult. They are difficult to get a history from.

The WBC can represent an infectious cause, or a non-infectious cause? The first step is to really get a good history and use all resources available to get this history, whether it is nursing home staff or a parent. So, really get a good history. But, Im here more to talk about objective findings.

The first is vital signs. We really need to get a good, valid temperature, and the best way to do that is with a rectal temperature. Axillary temperature and tympanic temperature are crap dont do it, and dont let the nurses do it. Oral temperature could be valid if you have a very compliant patient who can hold the thermometer under their tongue with mouth closed. But still, there is variability in how that temperature is obtained. If you want the best, valid temperature, get a rectal temperature. Now, do I do that in all my patients? No, of course I dont. A 30-year-old female who comes in with probable pneumonia, I dont do a rectal temperature. But, as a medical provider you are solely responsible for your patients health, and the most valid way to know if they have a fever or not is with a rectal temperature.

9 out of 10 patients that present with an infection is one of two things; either wind or water. Wind is pneumonia, and water is urine. You need to do a two-view chest x-ray and a urinalysis with culture. The lateral CXR allows us to see behind the heart, and into the lower fields to evaluate for fluid and opacity. So, two-view chest x-ray and get a urine.

This may all be simple, and some say common sense. It may be easy and a common practice, but, that is not always what we do. Make it so.

About the Author:
Emergency medicine requires knowing the bad things. From chest and pulmonary symptoms. but, equally as common is the patient with sepsis.
You have to master the septic evaluation. If you work in emergency medicine, sepsis will be one of your most life threatening emergencies. From patient presentation, to diagnosis, to antibiotics, you need a specific approach.



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