Failure to Diagnose & Delay in Treatment of Septic Shock

Evaluate breaches in the standard of care to determine if there has been a Failure to Diagnose & Delay in Treatment of Septic Shock

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Fever
    Increased heart rate
    Abnormal blood work suggestive of infection
    Symptoms not elicited
    Increased respiratory rate
    Answer unknown
    Why is this important?
    As the official sepsis definition requires a documented infection and systemic inflammatory response (SIRS), symptoms of sepsis may be vague.
    (2011) 63 JNLINF 6 407-419

  • Was a detailed medical history obtained? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.
    Click here for additional information at ClinicalKey.com

  • Was the patient’s skin assessed for temperature, rash or discoloration? Why is this important?
    Answer this question
    Pallor, grayish, or mottled skin are signs of poor tissue perfusion seen in septic shock. Common signs include cool, vasoconstricted skin due to redirection of blood flow to core organs. Attention must be paid to skin color and temperature.
    (2011) 37 JLEMNU 1 47-54

  • Was the patient’s urine output measured and recorded? Why is this important?
    Answer this question
    Decreased urine output is a sign of hypo-perfusion of the kidneys due to spetic shock..
    (2012) 13 EAICMD 5 199

  • Was a thorough physical examination performed on the patient? Why is this important?
    Answer this question
    A physical examination is required to assess the overall health and stability of the patient.
    Click here for additional information at ClinicalKey.com

  • Was a serum lactate level obtained? Why is this important?
    Answer this question
    Serum Lactate levels reflect the degree of hypo-perfusion and the severity of shock.
    (2011) 37 JLEMNU 1 47-54

  • Were diagnostic laboratory studies performed before the antibiotics were administered? Why is this important?
    Answer this question
    Diagnostic laboratory studies are necessary to assess the overall status of the patient. Baseline blood investigations must include complete blood count (CBC) and liver function tests, serum lactate levels, appropriate culture and sensitivity screening, and arterial blood gases.
    Click here for additional information at MD Consult.com

  • Was the patient's level of consciousness assessed? Why is this important?
    Answer this question
    Delirium may be the first sign of infection or sepsis, especially in the elderly.
    (2011) 37 JLEMNU 1 47-54

  • Were diagnostic imaging studies performed? Why is this important?
    Answer this question
    Tests of potential value for localizing infection and evaluating the need for surgical intervention include: (1) abdominal or pelvic ultrasound, and (2) computed tomography (CT) of the abdomen and thorax.
    (1999) 13 EIDCNA 2 495-509

  • When was the anatomic site of the infection isolated and treatment initiated? Why is this important?
    Answer this question
    Identifying the source of infection is an essential component of the early management of sepsis. The standard of accepted medical practice is to determine the contributing organism within 6 hours of presentation to the health care facility.
    (1999) 13 EIDCNA 2 495-509

  • Was the patient diagnosed with septic shock? Why is this important?
    Answer this question
    The diagnosis of septic shock is made when the following signs and symptoms are present:
    • Profound hypovolemia, hypo-perfusion, and hypoxia
    • Hypo-volemia (does not respond to fluid resuscitation)
    • Multiple organ failure.

    (2011) 37 JLEMNU 1 47-54

  • Was the patient started on antibiotics? Why is this important?
    Answer this question
    Prompt and organism specific medical intervention is needed to reduce the likelihood of systemic failure.
    (2011) 37 JLEMNU 1 47-54