Physician's Assistant

Met call Wed 11 June 2025 12:05

Last Modified: 299 days ago

MRN:

Content:

Reason for Call:
Patient with score 8 NEWS, hypotension and deterioration following defunctioning loop ileostomy on Friday. Concern for septic shock secondary to intra-abdominal infection.

A-E Assessment:
A - Airway: Patent, no concerns mentioned

B - Breathing: Bilateral pleural effusions on CT. Patient in positive fluid balance. No respiratory distress reported.

C - Circulation: Hypotensive requiring vasopressor support (noradrenaline). Fluid responsive hypotension. Distributive shock secondary to intra-abdominal sepsis. Heart rate elevated.

D - Disability: Alert and communicating. Blood glucose 11.9mmol/L.

E - Exposure: Temperature 38-39°C. Two drains in situ. New retroperitoneal collection identified on CT.

Investigations:
CT (1am today): Pancreatic-colonic fistula, bilateral pleural effusions, new retroperitoneal collection possibly communicating with pancreatic bed, no new intra-abdominal collections
Blood cultures: Taken at 05:00, results pending
Blood gas: Planned
ECG: Planned
Chest X-ray: Planned

Impression:
Septic shock secondary to intra-abdominal infection in patient with necrotising pancreatitis and pancreatic-colonic fistula. Post-operative day 5 following defunctioning loop ileostomy. Distributive shock with significant third spacing.

Plan:
- Continue noradrenaline to maintain blood pressure
- Venous blood gas
- Chest X-ray to exclude other post-operative complications
- ECG
- Consider echocardiogram
- Strict fluid balance monitoring
- Fluid boluses as needed to maintain blood pressure
- Hold TPN temporarily to exclude line sepsis
- Line change scheduled for this afternoon
- Continue IV antibiotics (meropenem)
- Discuss with Mr Briggs regarding surgical management of collection
- Consider endoscopic necrosectomy with Dr Suarez if appropriate

Team Leader: Tina (Intensivist)
Documentation Date: 25/06/11 12:05

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Summary:

Investigations:

Met call Wed 11 June 2025 12:05

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