Skinny Chick

[Blessed187]

Could a UTI get bad enough to turn into this situation? I would think the UTI would turn into a kidney infection soon enough then the pain alone would send her to a doc or the ED... Do you think she would of had a chance if there were no street drugs in her system?

Very sad.

 

[Smash]

Could a UTI get bad enough to turn into this situation? I would think the UTI would turn into a kidney infection soon enough then the pain alone would send her to a doc or the ED... Do you think she would of had a chance if there were no street drugs in her system?

Very sad.

UTI is the second most common cause of sepsis after chest infection.

n7lxi, was there any response to fluid challenge? How much was given?

 

[NomadicMedic]

I gave her 2000ml with only a small increase in pressure. I'm at work now, but I recall her last pressure with me was around 70/50.

 

[Bieber]

Could a UTI get bad enough to turn into this situation? I would think the UTI would turn into a kidney infection soon enough then the pain alone would send her to a doc or the ED... Do you think she would of had a chance if there were no street drugs in her system?

Very sad.

Like Smash said, urosepsis is fairly common, especially in nursing homes. The street drugs certainly didn't do her any favors, but it's impossible to say what the outcome would have been. Sepsis is bad, in drug addicts or otherwise.

 

[miranda]

Maybe????

Ok, so Ive only done ride alongs so far. I had a 19yr old male patient. O2 sat was 30. He was a drug overdose.
Im kinda basing these two in the same category, but I would think...maybe. Narcan- High Flow O2, prevention for shock and code 3 to the hospital.

 

[MediMike]

Interesting case, thanks for the headsup on the Neuroleptic Malignant deal, thats a new one to me.

 

[Smash]

I gave her 2000ml with only a small increase in pressure. I'm at work now, but I recall her last pressure with me was around 70/50.

Given her catastrophically bad perfusion and the lack of response to fluid (although 2000ml is a pretty small amount in this setting) was there a reason for not starting pressors?

 

[NomadicMedic]

Given her catastrophically bad perfusion and the lack of response to fluid (although 2000ml is a pretty small amount in this setting) was there a reason for not starting pressors?

I was very close to the hospital, less than 7 minutes. By the time I RSIed her and ran in the 2 bags, I was there.

They waited on pressors in the ED, too. I asked the doc why, he said he wanted to try to improver her pressure and perfusion with crystalloid.

 

[Atlas]

That was very interesting to read. A good many things to ponder about whilst heading to sleep

 

[Farmer2DO]

I agree with the holding of pressors. In order for them to work well, the tank needs to be full. It sounds like you were behind the 8 ball before you even walked in the door.

In our system, RSI is only standing orders if three criteria are met: 1) GCS less than or equal to 8 2) unable to maintain 90% or higher SPO2 with high flow oxygen and/or assisted ventilations 3) greater than 10 minute transport time. If all 3 criteria are not met, then we must call and ask for permission. For less than 10 minutes transport (which is almost always for me) it is almost always denied.

As for the source of the sepsis, I believe the 4 most common sources are renal/urinary, respiratory, abdominal/peritoneal, and CNS. I've heard the residents lectured that if they don't find the source in one of those 4 areas, go back and look, it is likely it was missed.

Smash is very wise. Dr. Emanuel Rivers at Henry Ford is the source of much of our current theory on sepsis and EGDT.

I also would not go with Narcan, since she is not an overt narcotic OD, and we are able to maintain her sats with assisted ventilations. It sounds likely for her to be a polysubstance abuser, so removing the narcotic (even though it wasn't there) and allowing the coke and meth to have unchallenged sympathetic overdrive would not make your job any easier.

 

[EMSrush]

Sad story, but good scenario to ponder...