You have alerted the doctor to the positive SIRS score on a patient

You have alerted the doctor to the positive SIRS score on a patient

Question You have alerted the doctor to the positive SIRS score on this patient. The lactate has come back at 4.6 mmol/L and the blood cultures are pending. The chest X ray shows consolidation in the lung bases consistent with pneumonia. The doctor believes the patient is septic and has initiated the sepsis order set. Since the blood culture and lactate are already drawn you administer the antibiotic and start fluid resuscitation (30 ml/Kg) patient weight is 96 kg. You start 3 L normal Saline to be administered over 1 ½ hours. After the fluid resuscitation the patients VS are as follows: Temp 101.1⁰F, HR 76/min, BP 90/52 mmHg (MAP 60), RR is 28/min, he is also requiring oxygen and is now on a 50% non-rebreather mask and is using accessory muscles to breath. He complains of being short of breath and appears anxious and confused. You also notice his extremities are cool to the touch. His urine output has gone down from 40 ml/hour to 15 ml/hour. You call the doctor to report the changing condition. The doctor would like to start him on a medication to increase his blood pressure and get his MAP > 65 mmHg (Levophed or norepinephrine). The doctor is considering intubation for this patient. What symptoms are concerning for shock? Why is this patient requiring increased oxygen and increasing use of accessory muscles? What organ dysfunctions can you recognize? Type of ShockCan you stage the shock?Clinical Manifestation

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