Deteriorating patient — data interpretation viva

This patient is critically ill and deteriorating, with a high early-warning score across every system, and meets the clinical picture of septic shock: hypotension, a markedly raised lactate, hypothermia, and confusion, all on a background of presumed infection. The pattern is one of decompensated septic shock with respiratory and neurological compromise, and she requires immediate resuscitation by a team, in parallel with the sepsis bundle.^[2]

Apply ABCDE as a cycle. Secure the airway and give high-flow oxygen for the hypoxaemia; the respiratory rate of 30 with saturation of 87 percent signals impending respiratory failure, so prepare for escalation. Establish intravenous access, send cultures and bloods including lactate and a gas, and give a balanced crystalloid bolus with reassessment, commencing vasopressors for fluid-refractory hypotension to a mean arterial pressure target. Give broad-spectrum antibiotics without delay — each additional hour to antibiotics was associated with higher mortality in mandated sepsis care — and arrange source control. Check a bedside glucose, then fully expose to seek the source while keeping her warm, since she is hypothermic.^{[3] [4]}