Pneumonia & septic shock
harry206 - 05-16-09 09:13

A 52 yo is admitted to the hospital with CC: cough and fever for 5 days.

Physical examination:
Febrile, tachycardic, hypotensive
CVS: Clear S1S2
Chest: decreased air entry on the right, dull percussion tone in R lung base
Abdomen: Soft, NT, ND, decreased BS
Extremities: no c/c/e

Imaging:
A CXR done one month ago


current CXR shows a RLL pneumonia and effusion


Laboratory results in a patient with pneumonia, septic shock, and acute renal failure (ARF)

What is the next step in the management?
The patient is hypotensive with BP 74/30, essentially in septic shock with acute renal insufficiency due to hypovolemia and hypotension.

She needs a central venous access as soon as possible in order to administer large amount of IV fluids (IVF) to correct the hypotension. A right IJ TLC (triple lumen catheter) was placed. Check the proper position of the TLC on the CXR below. It is exactly where it should be - in the distal superior vena cava (SVC).



A right IJ TLC in the distal SVC (correct position)

BP is better, SBP 101.

ABx started for empiric treatment of community-acquired pneumonia and septic shock

What happened next?
The vital signs stabilized with IVF. ARF and pneumonia resolved and the patient was discharged home.

Final diagnosis:
Pneumonia and septic shock