EMRA Simulation Guide

GU - Sepsis of Urinary Origin

CASE: 87-year-old female presents with altered mental status from the nursing home with EMS

Learning Objectives

1. Recognize when an adult has an immediate life-threatening condition
2. Manage a patient with impending shock
3. Create a broad differential for a patient with altered mental status
4. Order appropriate studies to elucidate the cause of patient’s clinical deterioration
5. Recognize what imaging and labs are most appropriate for the chief complaint of altered mental status
6. Understand the treatment for sepsis

Critical Actions

• Obtain IV access with two large-bore peripheral IVs
• Place patient on monitors with continuous oxygen saturation monitoring
• Ask for a full set of vital signs including HR, BP, oxygen saturation, and temperature
• Obtain EKG, CXR
• Recognize urinary retention and place urinary catheter
• Ask for and interpret appropriate labs (CBC, BMP, Cardiac biomarkers, UA, Urine Culture, Blood Cultures, VBG w/ lactate, procalcitonin)
• Administration of IV fluids
• Administration of antibiotics
• Recognize need for central venous catheter placement and describe procedure correctly.
• Obtain post-procedure CXR
• Reassessment of patient and vital signs
• Appropriate consultations called (MICU)
• Closed loop communication
• Synthesis of the case
• Disclose appropriate information to the patient/family

Download the case here.