Question

Because Jose’s condition is not improving:

The doctor orders another liter (L) of fluid (NS) and IV antibiotics and asks the nurse to get VS again as soon as the fluid is administered

1 L fluid is given at 2:10 pm

The antibiotic is started at 2:20 pm and takes 30 min to give

The doctor calls the nurse at 2:25 pm and tells her that he wants to start Early Goal Directed Therapy (EGDT) on Jose

The start time for EGDT is 1:40 pm when the lactate result of 4.2 came back from the lab. All interventions related to Jose’s care that have time frames associated with them are based on this start time.

The liter of fluid has been administered and at 2:30 the nurse checks Jose’s VS again as the doctor ordered. Jose’s vital signs are:

SBP = 85

HR = 105

RR = 25

T = 38.7° C

The sepsis catheter is inserted at 3:05 pm and the nurse starts monitoring the measurements from the catheter that give information that helps guide treatment for Jose. The doctor orders a chest X-ray to make sure the catheter is inserted correctly and makes arrangements to transfer Jose to the Intensive Care Unit (ICU) as soon as possible.

Here are the values recorded from the sepsis catheter:

Time	CVP	MAP	ScvO2
3:15 pm	4	56	60
3:40 pm	5	57
4:10 pm	5	56	62
4:45 pm	6	59
5:10 pm	8	60	65
5:40 pm	8	59
6:00 pm	10	62	64
6:30 pm	9	64
6:55 pm	9	67	66
7:15 pm	8	68
7:40 pm	9	68	68
8:15 pm	8	70
8:45 pm	10	69	69
9:10 pm	9	68
9:45 pm	9	72	72

The ED staff takes another lactate draw at 7:05 pm. The results from that draw arrive at 7:57 pm and are 2.3.

Based on this information, did the ED staff meet the EGDT goals outlined in the Sepsis Algorithm?

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Which of these were met?

Antibiotics given at the right time?

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Sepsis catheter inserted at the right time?

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CVP, MAP, ScvO2 targets?

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Decreased repeat lactate?

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Jose slowly improves over the next 2 days while in the ICU. He remains on IV antibiotics and is transferred to the Medical Surgical unit until he is discharged home 2 days later.

Answer 1

I think the Patient Jose admitted to the hospital for the treatment for Severe Sepsis and Septic Shock and the vital shows that the patient is presently suffering with hypotension,high heart rate and high fever

1.Antibiotics given at the time?

Any way you were not mention regarding the admission time in the data given,any way you were mentioned that the Jose's condition is not improving and the antibiotic is started at 2.30pm and is given for a 30 minutes period.According to the data given the antibiotic is not started at the proper time and shows some delay.Thus the patient condition is not improved

2.Central catheter or Central line inserted at the right time?

Septic catheter means an infected catheter,In any of the hospital policy no staff will insert a septic catheter,Instead of that it may a Central Catheter or Central line because of that to make sure the catheter inserted correctly or not,the doctor orders a chest X-ray.

Here according to he given data there is a delay in the catheter insertion.Here the cathter is inserted at 3.05 pm,already at the 2.30pm vitals after administering a litre of fluid the patient shows an hypotension.The centrall catheter is not inserted at the right time thus shows the delay in progress of patient,why because with the hypotension at 1.40 pm the lactate level of patient shows 4.2 that means the patient is having a severe infection/signs of Heart failure.The actual time to start an Early-Goal Directed Therapy is at 1.40pm,but the doctor calls the nurse to start a EGDT therapy at 2.25pm and the EGDT therapy needs a Central line or Cental catheter.

The values from the Central catheter are recorded from 3.15 pm onwards

3.CVP,MAP and ScvO₂ targets?

From the EGDT therapy from the 3.15 pm onwards the patient has received a a good therapy by colloids and crystalloids,vasoactive agents,transfusion of red cells and inotropic agents with in the time 3.15pm to 9.45 pm the targets have been acheived in CVP,MAP and ScvO₂.

4.Decreased repeat lactate?

In the second lactate draw at 7.05 pm after initiation of a EGDT(therapy),report arrived at 7.57 pm shows a decrease in the lactate level from 4.2 to a level of 2.3.