ABSTRACT
From a data point of view, be familiar with requesting and interpreting the key diagnostic tests for different infectious diseases.
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A 62-year-old man is brought into the resuscitation room having collapsed at home. He is confused with a GCS of 13. Other observations include temperature 34.7 °C, heart rate 128 bpm regular and blood pressure 77/47 mmHg. He has cool and cyanosed peripheries. You place him on oxygen, initiate fluid resuscitation and obtain an arterial gas sample, as well as requesting an urgent plasma lactate level and full blood count. The results of these investigations are shown below:
pH 7.21 Hb 11.7 g/dL pCO2 3.1 kPa WCC 2.1 × 10
9/L pO2 10.8 kPa Platelets 110 × 10
9/L BE –13.3 Plasma lactate 6.9 mmol/L
a What are the four systemic inflammatory response syndrome (SIRS) criteria? Does this patient have SIRS? [5]
b What is the normal range for plasma lactate? [1] c Define severe sepsis? [2] d Give three treatment ‘goals’ which are aimed for in the early treatment of
severe sepsis. [3] e Which vasopressor drug is most suitable for use in hypotension associated
with severe sepsis unresponsive to fluid therapy? [1] [12]
A 38-year-old zoo-keeper presents to the Emergency Department (ED) with a painful, red and hot patch of skin around a small oozing scratch-mark on the dorsum of his left hand. Otherwise, he feels well. He states that he was bitten by a bat at the zoo whilst cleaning a cage three days ago. He is not sure of his tetanus vaccination status. His observations are all within normal limits and he can move all his fingers normally.
