A 35 year old patient presents to the ED with a surgical site infection and is 2 weeks post op TAH. Noted was wounded drain, foul odor, no pain, vital signs as follows; heart rate 132, respiratory rate 26, anxious, hx. of diabetes. In this case the patient had a CBC done which was unremarkable. The wound was cleansed, patient was sent home on antibiotics and Ativan for anxiety, Demerol for pain. No differential was ordered, no CT of the abdomen to rule out fistula, and there is a source. I have not seen Demerol used for pain since the 1980's.
The clinician at bedside will make the clinical judgment as to whether or not a patient has sepsis or not, do not be misled if the patient presents with no fever. The patient need only have two of the following indicators to be diagnosed as early sepsis.
Temperature> 38.5 degrees C or <35 degrees C
· Heart rate> 90 beats / min
· Respiratory rate> 20 breaths / min or PaCO2 <32 mmHg
· WBC> 12,000 cells / mm3, <4000 cells / mm3, or> 10 percent immature band forms.
Litigation may exist when patients are not screened appropriately in the presence of a source, such as a surgical wound. I have seen many cases where laboratory tests did not include a differential or clinicians only looking for a febrile condition. This is a trick diagnoses that requires a complete assessment of the entire history. Look at the patient. If they look sick, then they are sick. Early sepsis is treatable. The earliest intervention a nurse can do is notify the physician, if in the home health setting or acute care setting. In the ED nurses can advocate for their patients on treatment modalities, admission and discharges. Progression to Sepsis and Septic Shock can be irreversible if early identification Is compromised. Nurses are key to identification, notification, and utilizing resources to advocate the appropriate clinical setting for the aggressive treatment of these patients.