Colorado Hospital Association Clinical Scenario Mr Peabody Mr Peabody is a 67 yearold male who arrived by EMS from his primary care physicians office where he was short of breath and suspected to have pneumonia ID: 779972
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Sepsis TableTop Scenario
Colorado Hospital Association
Slide2Clinical Scenario – Mr. Peabody
Mr. Peabody is a 67 year-old male who arrived by EMS from his primary care physician’s office where he was short of breath and suspected to have pneumonia.
PMH: current smoker for 50 years, COPD, 2L home oxygen, hypertension, right total hip replacement 10 weeks ago post fall.
Slide31300 – Initial EMS Vital Signs
BP 136/70
HR 100 sinus tach
RR 20
Temp 99.5°FSpO2 94% 2L NC Transport paramedic assessment: awake, alert and oriented. Decreased lung sounds at the left base. Productive cough, yellow thick sputum.
Clinical Scenario – Mr. Peabody
Slide41315 – Transport VitalsBP 105/62
HR 100 sinus tach
RR 25
Temp 101.7° F
SpO2 94% 4L NC
Clinical Scenario – Mr. Peabody
Slide51330 – Arrival in Emergency Department
BP 86/42
HR 125 sinus tach
RR 28
Temp 101.3°FSpO2 95% 4L NCAssessment: alert and oriented x3. Decreased lung sounds at the left base. Productive cough, yellow thick sputum. Right hip incision is pink and closed. Weight 85 kg.
Clinical Scenario – Mr. Peabody
Slide6Initial Labs (resulted at 1430)
Drawn in triage
Basic Metabolic Panel
Reference Range
Sodium
143
135-147 mmol/L
Potassium
3.8
3.5-5.2 mmol/L
Chloride
101
95-107 mmol/LCreatinine2.50.5-1.2 mg/dLGlucose14660-110 mg/dLLactate:3.90.5-1.0 mmol/L
CBC
Reference Range
Male
Female
WBC
13.0
4,500-10,111 K/uL
Hemoglobin
8.7
13.5-16.5 g/dL
12.0-15.0 g/dL
Hematocrit
39.2
36-48%
Platelet
258
140-450 K/mcL
Chest x-ray
LLL infiltrate
Slide71500 – Completed Interventions
Fluids = 30 mL/kg at 1430
Blood cultures at 1400
Antibiotics at 1430
Lactate level . . . to be repeated now
Tylenol at 1330
Clinical Scenario – Mr. Peabody
Slide81500 – Latest VitalsBP 98/55
HR 125 sinus tach
RR 28
Temp 100.4°F
SpO2 93% 4L NC
Clinical Scenario – Mr. Peabody
Slide91515 – 15 Minutes LaterBP 94/45
HR 130 sinus tach
RR 32
Temp 100.4°F
SpO2 90% 4L NC POC lactate: 2.7
Clinical Scenario – Mr. Peabody
Slide10TRANSFER