Thread by @WesElyMD

1/🧵#SEPSIS is URGENT. Here it was caught way too late! Sepsis is marked by WBCs (White Blood Cells) either too high OR too low. If someone’s WBC drops from 14k to 6k to 3k WITHOUT antibiotics, that’s a total catastrophe & usually means death is closing in.👇

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2/ So hypothetically (& I’m changing details to make this situation unrecognizable to the real patient my comment is based on)…if a month after a knee replacement someone comes in complaining of NEW knee pain and no fever…

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3/ …with a WBC count of 14,000, scans & xrays not showing an abscess, an infected prosthetic joint is still my #1 Dx unless there is a completely obvious other cause of infection. Said another way, this is sepsis due to an infected knee until proven otherwise.

4/ This patient had a BP of 110/55 & Creatinine of 2.7 (no hx of kidney problems). That is an acutely failing kidney situation (called AKI – acute kidney injury) & it signals that the dominoes are starting to fall in this person’s body! They should NOT be admitted to the floor.

5/ This pt needs TWO things straight away – Source Control if possible (consider drainage of an abscess or removal of the prosthetic joint) and Antibiotics. Delay of either into double-digit hours is 💯 NOT OK.  It’s essentially an emergency & needs to be handled immediately.

6/ Waiting 12 hours to remove the source and get antibiotics is like knowing that a bridge has fallen into the river and allowing a train to keep going toward the river. It is going to crash into the water unless you remove the source and kill the bacteria.

7/ I am writing this so that families feel empowered to be a squeaky wheel about getting timely management of sepsis AND so that we in the medical profession don’t allow silos of communication to get in the way of best care.

8/ I’m recalling Eugene Stead’s call-to-arms for physicians entitled - What this patient needs is a doctor!

"No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician…

read on👇

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9/ “In the core of the suffering, one needs technical skill, scientific knowledge, and human understanding. He/she who uses these with courage, with humility and with wisdom will provide a unique service for others and will build an enduring edifice of character…

10/fin
“…The physician should ask of her/his destiny no more than this and should be content with no less."
 
Stead: What This Patient Needs Is a Doctor, ed GS Wagner, Durham, NC, Carolina Acad Press 1978.
 
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