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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the signs and symptoms of systemic inflammatory response syndrome (SIRS), sepsis, and severe sepsis

  • Identify the initial goals of therapy for the treatment of patients with sepsis

  • Devise an appropriate initial treatment plan, including fluid resuscitation and antibiotics, on the basis of patient characteristics and circumstances surrounding the patient's presentation

  • Formulate a monitoring plan for the initial treatment while considering chosen therapies

  • Determine the appropriateness of additional pharmacologic therapies for sepsis, including vasoactive agents and corticosteroids, as well as adjunctive therapies

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PATIENT PRESENTATION

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Chief Complaint

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"My father is confused and not responding to me. He looks pale and fatigued."

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History of Present Illness

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James Stallings is an 84-year-old male who was brought to the emergency department via emergency medical services (EMS) after his daughter found him sitting on the floor of his kitchen. She visits him at home twice a week to help him with his medications and other chores around the house, but he is normally very independent in his ADL despite having a stroke within the past year. She says that he has some small memory deficits post-stroke, but his current mental status is much more altered than his baseline. The last time she checked on him was 3 days ago when she took him to his primary care physician (PCP) for evaluation of a respiratory infection and an INR check. At that time, he was prescribed a course of antibiotics. She believes that he is compliant with his medications since she puts them in a pillbox for him and the medications are always gone when she returns. The EMS medic reports that the patient was hypotensive on arrival with SBPs in the 90s mm Hg and was subsequently given a 500-mL bolus of 0.9% sodium chloride en route to the emergency department. The medic also states that the patient would only intermittently answer questions, and was not aware of his current situation.

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Past Medical History

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BPH × 7 years

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Type 2 DM × 9 months

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HTN × 35 years

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AF × 2 years

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Cerebral vascular accident diagnosed 7 months ago

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Depression × 4 years

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Family History

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Father died of a CVA at age 89. Mother died of bladder cancer at age 90. He has 2 brothers, one of which died at age 65 due to lung cancer and one alive at age 89 with a medical history that includes HTN, AF, and Parkinson's disease. He has 2 daughters, who are both alive and healthy.

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Social History

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Retired US Air Force and commercial airline pilot. Has lived alone since his wife passed away at age 80 due to colon cancer. Has 2 ...

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