Sepsis

Question 1

Definition of HAP ?

Answer 1

hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after hospital admission and is not present at the admission time

Question 2

assess the patient ?

Answer 2

on B - ABG

on C - urine output
would need catheterisation if urine output deteriorating
blood culture

E - GCS

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ONCE I HAVE DONE THIS I WILL ATTEMPT TO TAKE A BRIEF HISTORY LOKING AT THE PATIENT NOTES AND REASOM FOR ADMISSION

Question 3

This patient has been admitted under the gastroenterology team for management of his Crohn’s disease and is on long term immunosuppression. Would you add anything to your suspected diagnosis or your management?

Answer 3

My differential diagnosis is still the same for this patient; although now that I know he is immunocompromised, I would make sure that we include investigations for opportunistic infections such as tuberculosis, and be cautious of the potential for complicated parapneumonic effusions and empyema.

fungal infections : P jiroverci , cryptococcus

toxoplasma , cryptosporidiasis

re-examine make sure no other systemic features of infection that I may have previously missed. He is especially at risk of intra-abdominal collections, which may present with fever and hypoxia so I would ensure I closely examine his abdomen.

I would discuss this patient with the on call microbiology team. I would like advice on whether the broad-spectrum antibiotic regimen I have prescribed would provide suitable cover for a patient who is immunocompromised.

This patient is also at greater risk of developing viral respiratory infections and may be more liable to quickly deteriorate if this represents an infection with COVID-19. I would therefore make sure the ITU team were aware of this new information if they had not seen the patient at this point.