Patient Encounter Part 1

A 67-year-old man with a history of chronic obstructive pulmonary disease presents to the emergency department with high fevers, shaking chills, severe chest pain, and shortness of breath. His family members state that he has been confused all day. He started having a severe cough 2 days ago, with excessive sputum production. He received doxycycline 100 mg twice daily for an upper respiratory tract infection 7 days ago.

What information is suggestive of infection and/or sepsis?

Does this patient have factors that could lead to the development of sepsis? What information do we need in order to confirm or diagnose sepsis in this patient?

Cultures to obtain if clinical situation suggests infection of specific fluids, tissues, or organs include:

• Urine culture and urinalysis, respiratory secretions, cerebrospinal fluid, wounds

• Laboratory tests to evaluate infection or complications of sepsis include: CBC with differential; coagulation parameters; basic metabolic panel; serum lactate concentration; arterial blood gas.

The use of biomarkers of sepsis have been controversial. Measurement of endotox-in, procalcitonin, or other markers in blood or serum is not routinely recommended. Concentrations of procalcitonin in serum are usually increased in sepsis, but fail to differentiate between infection and inflammation. However, procalcitonin has a high negative predictive value and could allow for the discontinuation of antibiotics.

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