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    Suggest treatment for suspected blood sepsis

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Posted on Wed, 12 Jul 2017 in Elderly Problems
Question: May I have your personal opinion on a certain matter? If there is sufficient evidence that an 88 year-old comorbid patient has sepsis but is still considered to be treatable, would a delay in administering antibiotics of four and a half hours be reasonable, presuming that there is plenty of time to administer the antibiotics sooner?
doctor
Answered by Dr. Ivo Ditah 1 hour later
Brief Answer:
What are they doing in the interim?

Detailed Answer:
Hi and thanks so much for this query.

Before responding, I will like to obtain more details from you.

1. What are they doing in the interim? is it about getting samples for laboratory investigation? if this is the case it is often advised to get samples before administering any antibiotics because this might make germ isolation difficult and result in treatment failure.

2. while fours hours is much, this is evaluated based on the reasons for delay. some other important issues might be under review and that's the reason which could be totally justified.

3. What is her health status? is she conscious? able to dialogue normally? what's the temperature and heart rate?

Let me hear From you and promise to provide more insights and a definitive opinion when the above details get to me.

waiting...


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ivo Ditah 19 hours later
Thank you Dr. Ditah for your response!
The patient had suspected sepsis and a septic work up was given. Blood cultures and blood gases were quickly taken. An ECG was also done. All of the pathology results, except the blood cultures, were back and written up by 1045 hours. All of this occurred before 11.00 pm. At 11.00 pm antibiotics were ordered. In so far as I am aware, nothing then happened until a CT Brain non-contrast scan was done at 1.08 pm and a Chest x-ray at 1.11 pm. Even after the CT scan and Chest X-ray were done there was time for the patient to be seen at 14.30 hours by a physiotherapist. It was not until 15.40 hours that the first antibiotic (ceftriaxone) was administered. Thus there was a delay of 4.40 hours. Oddly normal saline was not administered until 1620 hours. I don't understand why they weren't given simultaneously.
The venous lactate was 4.1; the patient's Sp02 with a Hudson Mask on was 92% and his saturation on room air was 81%. His temperature at 11.00 pm was low at 34.5C (but the patient's temperature is often low). The heart rate was 92 at 11.00 pm. The patient looks distressed, disorientated and is presently incomprehensible, and at 11.00 pm had fluctuating levels of consciousness. The patient is also immunocompromised because he has a myeloproliferative disorder and diabetes T2 for about 15 years.
I hope that this helps. I may be able to provide a little more information if it is required.

The patient also had a recent invasive procedure.
doctor
Answered by Dr. Ivo Ditah 1 hour later
Brief Answer:
They should have administered this earlier!

Detailed Answer:
Hi,

I seem unable to understand why they had to delay this first dose of antibiotics.Given her immune suppressed state, I would have expected them to administer the drugs as soon as the decision was made and all other samples, especially blood cultures collected. I will suggest you try to ask why they accumulated these extra hours before starting her very important medications.

How is she doing? Getting better?

Keep me updated!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ivo Ditah

Internal Medicine Specialist

Practicing since :2002

Answered : 3922 Questions

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