From the Guidelines
I strongly recommend giving a 500-1000 mL fluid bolus of normal saline and repeating a lactic acid level to address the patient's ongoing sepsis and potential tissue hypoperfusion. The patient is showing concerning signs of sepsis with persistent tachycardia (HR 110-120s), fever (though improved from 101.5°F to 100.1°F after Tylenol), and a history of pneumonia, sepsis, and UTI. While her blood pressure is currently stable (108/63, MAP 75), the tachycardia suggests compensatory mechanisms are working to maintain perfusion. Fluid resuscitation is appropriate given these vital sign changes and her infectious diagnosis, as recommended by the Surviving Sepsis Campaign guidelines 1.
The guidelines suggest that at least 30 mL/kg of IV crystalloid fluid be given within the first 3 hours, and that additional fluids be guided by frequent reassessment of hemodynamic status 1. In this case, a fluid bolus is warranted to help improve tissue perfusion and reduce the risk of organ dysfunction.
Continue with the scheduled azactam antibiotic as planned, as the administration of effective IV antimicrobials within the first hour of recognition of septic shock is a strong recommendation, moderate quality of evidence 1. After the fluid bolus, reassess vital signs, particularly heart rate and blood pressure. The repeat lactic acid will help evaluate tissue perfusion and determine if her sepsis is worsening despite antibiotics. If the lactic acid is elevated or increasing compared to previous values, or if tachycardia persists after fluid administration, consider escalating care and notifying the rapid response team before transfer to the floor.
Key considerations in the management of sepsis include:
- Fluid resuscitation to improve tissue perfusion
- Administration of effective IV antimicrobials within the first hour of recognition of septic shock
- Reassessment of hemodynamic status and adjustment of fluid and antimicrobial therapy as needed
- Monitoring of lactic acid levels to evaluate tissue perfusion and guide therapy
- Consideration of escalating care and notifying the rapid response team if the patient's condition worsens or fails to improve with initial therapy.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient Assessment and Management
- The patient is experiencing a spike in temperature (101.5°F) and heart rate (110-120s), with a blood pressure of 108/63 and a mean arterial pressure (MAP) of 75, indicating potential sepsis or septic shock 2, 3.
- The patient has been administered Tylenol, Dilaudid, and Compazine, with some improvement in pain, but the heart rate remains elevated 3.
- The patient is due for antibiotic Azactam, which should be administered as scheduled.
Fluid Resuscitation and Management
- Fluid resuscitation is a crucial aspect of sepsis management, with the goal of maintaining adequate blood pressure and perfusion of vital organs 4, 5, 6.
- The choice of fluid for resuscitation is important, with balanced crystalloids or albumin potentially associated with reduced mortality compared to other fluids 4, 5.
- Lactated Ringer's solution may be a suitable choice for initial fluid resuscitation, as it has been associated with improved survival in patients with sepsis-induced hypotension 5.
Lactic Acid and Repeat Measurements
- Lactic acid levels can be an important indicator of tissue perfusion and oxygenation, and repeat measurements may be useful in monitoring the patient's response to treatment 6, 3.
- The patient's lactic acid level should be repeated to assess for any changes or improvements in tissue perfusion and oxygenation.
Next Steps
- Administer the scheduled antibiotic Azactam 3.
- Consider a bolus of fluids, such as lactated Ringer's solution, to support blood pressure and perfusion of vital organs 4, 5, 6.
- Repeat measurements of vital signs, including heart rate, blood pressure, and lactic acid level, to monitor the patient's response to treatment 2, 6, 3.