Diagnosis of Shock Case 3

A 20-year-old student is brought to the ED by friends who have found her in bed drowsy and confused. They report that she had been unwell with flu-like symptoms for 24 hours. On examination, she is drowsy (E2, M5, V3) but has a patent airway and is pyrexial. She has a non-blanching petechial rash on her torso and cool peripheries.

Observations:

• HR 120
• BP 85/45
• RR 30
• sO₂ (poor trace)
• 86% (on air)

Which features support a diagnosis of shock?

Having decided that she is shocked, you need to identify which of the possible actions shown are the five you would carry out as a priority.

Now place your actions in the order you would carry them out.

Select the correct order from 1-5.

One hour later, she has had 3L of crystalloid, 2g of IVcefotaxime and is on high-flow oxygen. A chest x-ray has shown no focal consolidation but some slight bilateral generalised haziness.

Observations show:

• BP 85/50
• HR 130
• sO² 92%
• RR 45
• The arterial blood gas has only just been done and shows pO² 8.9 kPa, pCO² 3.2kPa, pH 7.23, Bic 13, lactate 6.8.

Which of the following statements are correct?