Introduction
Shirley Temple is a 75-year-old lady who has presented to her local emergency department complaining of an increased need to urinate as well as pain and burning when urinating. Her husband John has accompanied her, and is concerned as he believes Shirley is “just not herself” and slightly confused. It is assumed that Shirley is suffering from a urinary tract infection and possible Sepsis, warranting further investigation and management. This case study will outline what constitutes a diagnosis of Sepsis, its pathophysiology and its effects on the body, and management in the Emergency Department, ward environment and Intensive Care Unit.
Sepsis: definition, assessment and management
Sepsis is defined as “life threatening …show more content…
Shirley’s husband John mentions that he believes Shirley has become confused and this is not her usual baseline. As sepsis causes a wide spread inflammatory response in the body, the membranes of the brain become irritated and activate cerebral endothelial cells, resulting in the dysfunction of the blood brain barrier. This dysfunction allows proinflammatory mediators into the brain and can cause swelling of the brain tissue. As the blood brain barrier increases in permeability, toxic and infectious substances can easily enter the brain, causing further damage, whilst cerebral oedema can inhibit blood flow, tissue perfusion and the brains ability to receive adequate nutrition and oxygenation. As Shirley’s blood pressure is low this can also affect cerebral perfusion due to decreased tissue oxygenation and lead to confusion and ultimately …show more content…
A rise in blood pressure with a MAP of above 65mmHg indicates that Shirley’s organs are receiving adequate perfusion and that vasodilation and hypotension due to cell mediation and decreased fluid volume is no longer occurring. Her urine output has increased from 35ml an hour to 50ml an hour due to reperfusion of her kidneys. Administration of intravenous fluids assisted to rehydrate tissues and expand fluid volume in her body.
Shirley’s GCS has returned to her baseline of 15/15. Her brain is better able to receive oxygen due to return of normal vasoconstriction and her CRP results are trending downwards as her intravenous antibiotics are fighting the infection in her blood stream. Administration of supplemental oxygen has increased cerebral
Shirley Temple is a 75-year-old lady who has presented to her local emergency department complaining of an increased need to urinate as well as pain and burning when urinating. Her husband John has accompanied her, and is concerned as he believes Shirley is “just not herself” and slightly confused. It is assumed that Shirley is suffering from a urinary tract infection and possible Sepsis, warranting further investigation and management. This case study will outline what constitutes a diagnosis of Sepsis, its pathophysiology and its effects on the body, and management in the Emergency Department, ward environment and Intensive Care Unit.
Sepsis: definition, assessment and management
Sepsis is defined as “life threatening …show more content…
Shirley’s husband John mentions that he believes Shirley has become confused and this is not her usual baseline. As sepsis causes a wide spread inflammatory response in the body, the membranes of the brain become irritated and activate cerebral endothelial cells, resulting in the dysfunction of the blood brain barrier. This dysfunction allows proinflammatory mediators into the brain and can cause swelling of the brain tissue. As the blood brain barrier increases in permeability, toxic and infectious substances can easily enter the brain, causing further damage, whilst cerebral oedema can inhibit blood flow, tissue perfusion and the brains ability to receive adequate nutrition and oxygenation. As Shirley’s blood pressure is low this can also affect cerebral perfusion due to decreased tissue oxygenation and lead to confusion and ultimately …show more content…
A rise in blood pressure with a MAP of above 65mmHg indicates that Shirley’s organs are receiving adequate perfusion and that vasodilation and hypotension due to cell mediation and decreased fluid volume is no longer occurring. Her urine output has increased from 35ml an hour to 50ml an hour due to reperfusion of her kidneys. Administration of intravenous fluids assisted to rehydrate tissues and expand fluid volume in her body.
Shirley’s GCS has returned to her baseline of 15/15. Her brain is better able to receive oxygen due to return of normal vasoconstriction and her CRP results are trending downwards as her intravenous antibiotics are fighting the infection in her blood stream. Administration of supplemental oxygen has increased cerebral