SimMan: Urosepsis

Casebank Simman
1

You are FY2 in Accident and Emergency Department.
Elderly male, came to the hospital 1 week ago with UTI. Catheterised for 3 weeks. Confused since 3 days. Antibiotics given. Patient is waiting for TURP.

Airway

Mumbling: NPA, GCS (usually above 8)

Breathing

RR normal, SpO2 normal
Chest clear on auscultation
Do CXR, ABG (for lactates) regardless
of normal breathing

Circulation

  • Low BP, high HR.
  • 2 large bore IV cannulas
  • Sepsis screening: give 3 (Antibiotics, fluids, O2) take 3 (blood culture, lactates, urine output- change catheter and obtain culture from old catheter) along with routine investigations

Disability

  • Febrile
  • BSL normal
  • Pupils normal

Exposure

Frothy and turbid urine in catheter and urobag. So I am suspecting urosepsis, hence I would like to perform sepsis screening.

Recommendation

Admit, observe, senior, investigations, ECG, invite urologist for broad spectrum antibiotics, USG.

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4

Sepsis - Catheter Associated UTI

Where you Are:
You are an FY2 in the A&E.

Who the patient is:
Mr. Lincoln Peterson, a 60-year old gentleman presented with confusion.

What you must do:
Take a focused history, assess his condition and manage him accordingly.

Monitor: O2 = Normal or low, BP = normal or low, H.R. = 120, RR 24, Temp 39.

History:

  • Patient can answer questions with full sentences:
  • Analyse abdominal pain via SOCRATES.
  • Ask about urinary symptoms.
  • Ask about regular medications, medical conditions and allergies.

ABCDE Assessment

A - Airway

  • Check for any obstruction.
  • If SO2 Low: give oxygen via non-rebreather mask 100% oxygen 15L/min.

B - Breathing

  • Examine the chest in order: Inspection, palpation, percussion, auscultation.
  • Order Chest X-ray and ABG. Lactate will be more than 2.

C - Circulation

  • Check: pulse + CRT + BP + Insert 1 cannula.
  • Request routine bloods, infection markers.
  • Request ECG.
  • If the blood pressure is low give 500ml of fluids over 15 minutes.

D- Disability

  • Check: Blood Sugar + Temperature + Pupils
  • Temp 39: give paracetamol 1 g IV and start brand spectrum antibiotics.
  • Request blood cultures.
  • Re-assess blood pressure and if still low give additional 500ml of fluids over 15 minutes up to 2L in the 1st hour

E - Exposure

  • Examine the abdomen, legs and private area.
  • Change the catheter and take urine culture.
  • Start your discussion with the patient.

Handover

  • 2 mins SBAR

Situation

  • I am Dr (ā€”). I managed a 60-year-old male patient, Lincon Peterson, who presented to A&E with confusion.

Background

  • Jack had abdominal pain on background of long term catheter. He has no known allergies.

Assessment

  • On initial assessment, his vital signs were unstable and the temperature was high. So, I suspected sepsis and followed the sepsis six pathway. I gave him 100%O2 at 15L via a non-rebreather mask. I then administered IV fluid 500 ml and IV broad spectrum AB. I took blood from him for blood culture and other routine investigations. I performed ABG to check blood gas and lactate. I removed the old catheter and inserted a new catheter to measure the urine
    output. I also sent urine for culture and sensitivity. I gave him IV paracetamol 1g for his fever.

Recommendation

  • After the initial treatment, his vitals improved. Now, his vitals are (------). My recommendation is to admit this patient to the ICU. In the meantime, Iā€™d like to continue monitoring his vital signs and response to the treatment closely. I would like to change the antibiotics according to his C&S result .