The sepsis patient not improving after IV fluids and resuscitation: What should be considered? How can we improve?
You are in the midst of caring for a 62 year-old male who is tachycardic with HR 120, BP 88/42, T 101.2 oF, RR 26, and SpO2 98%. He was brought in by EMS for fever and myalgias, and with one look at his vital signs, he triggered the protocol for SIRS.
Your initial exam showed similar vital signs, with dry mucous membranes but otherwise normal HEENT exam, clear lungs, normal mental status, nontender abdomen, normal skin and genitourinary exams, and normal extremities/back. Due to his vital signs and SIRS criteria, you were concerned and ordered CBC, RFP, LFT, lactate, blood cultures, urinalysis/culture, and chest xray. You started 1 L NS, and his VS did not improve.