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CRITICAL THINKING
Your patient is experiencing respiratory distress
- Common triggers: O2 Sats dropping, increased work of breathing, RR >30, Sudden need for high O2 (NRB, HFNC), airway obstruction
- Typical diagnoses behind it: Pneumonia, Pulmonary edema or CHF Exacerbation, COPD Exacerbation, Aspiration, Pulmonary embolism, Mucus plus, Pneumothorax
- What to do?: Get full set of vitals, Check RR, + Cont. pulse ox. Check ABCs, RR, Lung sounds, skin for cyanosis and cap refill, mental status, and skin color.
- The 10-Second Respiratory Distress Assessment: Look at the patient and ask yourself are they using accessory muscles, do they look anxious, are they pale or cyanotic, can they speak in full sentences. Hude red flag is tripod positioning, gasps between words, extreme agitation or sudden confusion. Listen for wheezing, gurgling, stridor, rapid shallow breathing. Look for uneven chest rise, very fast or shallow breathing.
- Ask: Are you having trouble breathing? Full sentence → usually stable, Short phrases → moderate distress, One word or nodding → severe distress
- EMERGENCY: RR > 30, desatting under 90, and HR >120 with distress.
- Sit patient upright in high-fowler's, and apply oxygen or increase oxygen. Get OxyMask if needed. Notify Charge RN, Provider, RT and RR if patient is unstable.
- Orders to anticipate: Chest XRay, Neb treatments, Lasix, Steroids, BiPAP, ABG.
- Lastly, Document: Time symptoms started, respiratory findings, oxygen interventions, who you notified, patient response.
Your patient is septic going into septic shock
- Catch it early. Common signs include: Hypotension (SBP < 90, MAP < 65) especially if trending down, Tachycardia, Fever or Hypothermia, Tachypnea, Altered mental status from baseline, Decreased urine output, Lactate trending up, Mottled skin, cool/clammy skin or warm flushed skin, increased oxygen requirement.
- Start Rapid Assessment: Airway, breathing, circulation, mental status. Notify MD and charge RN IMMEDIATELY.
- Get fresh full set of vitals, mental status, urine output, and skin perfusion.
- Apply nasal cannula, ensure at least 2 large bore IVs. Anticipate fluid bolus and IV Antibiotics STAT
Anticipate typical sepsis labs: Lactate, CBC, CMP, Procalcitonin (sometimes), Blood cultures, ABG/VBG, Coags.
- Administer antibiotics within an hour: usually Broad spectrum such as vanco, zosyn, cefepime, meropenem
- The simple rule: If you see: Suspected infection + hypotension + altered mental status → Call RRT immediately.
- 10-second sepsis check: Do they look pale and clammy? Is mental status different or "off"? Is RR high? Is BP trending down?
- RRT Arrives. What is your SBAR? "I'm calling a rapid response for suspected sepsis. My patient in room 9A has a BP of 84/52, HR 118, RR 26, and is newly confused. They have a suspected UTI and look acutely worse. I have oxygen on, started fluids, and I'm concerned they're becoming septic."