RT Book, Section
A1 Oettinger, Glenn
A1 Zhang, Luyi Kathy
A2 Lee, Kiwon
SR Print(0)
ID 1163957510
T1 Antimicrobial Therapies in the ICU
T2 The NeuroICU Book, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071841443
LK neurology.mhmedical.com/content.aspx?aid=1163957510
RD 2024/04/19
AB A  53-year-old  man  suffered  a  severe  traumatic  brain  injury  after  being  struck  in  an  automobile-pedestrian  accident.  He  was  intubated  in  the  field  and  stabilized  in  the  emergency  department  (ED).  He  has  a  previous  history  of  a  hernia  repair  (15  years)  and  no  pertinent  social  history.  His  admission  height  and  weight  are  71  inches  and  80  kg,  respectively.  He  remains  stable  until  hospital  day  7  when  a  leukocytosis  develops  (WBCs  10.6  to  15.7  cells/mm3),  and  he  was  febrile  overnight  (Tmax,  rectal  101.2°F)  and  develops  macroscopically  cloudy  urine.  The  serum  creatinine  level  rose  from  baseline  0.8  mg/dL  to  2.1  mg/dL.  A  Foley  catheter  is  in  place.  Serum  lactate  concentration  is  at  4.4  mmol/L  His  morning  chest  radiograph  is  unremarkable,  showing  an  endotracheal  tube  in  good  position.  Urinalysis  is  reported  as  cloudy  with  WBC  clumps,  30  WBCs,  and  positive  leukocyte  esterase.  Arterial  blood  gas  levels  on  an  inspiratory  oxygen  concentration  of  40%  are  as  follows:  pH  7.31,  Paco2,  36  mm  Hg;  Pao2,  76  mm  Hg;  and  HCO3–,  20  mEq/L;  blood  pressure  (BP),  91/50  mm  Hg  (mean  arterial  pressure  [MAP],  64  mm  Hg);  heart  rate  (HR),  109  bpm;  respiratory  rate  (RR),  29  bpm.  The  team  diagnoses  this  patient  with  severe  sepsis  and  activates  the  institution’s  severe  sepsis  pathway.  They  draw  blood  and  urine  cultures,  initiate  fluid  resuscitation  with  a  normal  saline  bolus  of  30  mL/kg,  and  empiric  antibiotics  are  started.