Sepsis and Disseminated Intravascular Coagulation
A 72-year-old Caucasian man is admitted to the medical intensive care unit (MICU) with hypotension, fever (102"F), vomiting, and altered mental status. He has a history of chronic lymphocytic leukemia (not currently on active treatment), prostatic hypertrophy, and peptic ulcer disease. He is disoriented to place and time. Initial assessment data include BP 80/62 mm Hg, HR 120 beats/min, RR 36 breaths/min and labored, and a small amount of cloudy urine per catheter. A dressing covering his intravascular venous port shows tan drainage and redness around the site. Nasogastric aspirate is coffee ground in appearance. His initial laboratory data include:
Eight hours later, after administration of fluids and initiation of a norepinephrine infusion, the patient's BP is 102/84 mm Hg, heart rate is 104 beats/min, and respiratory rate is 24 breaths/min on continuous positive airway pressure (CPAP) via mask. The lab work is repeated.
What are this patient's risk factors for hematologic and immune problems?
What diagnostic testing should be done?
Identify the therapeutic interventions that are the highest priority.
Analyze the patient's initial lab work and outline how the values provide diagnostic information.
Analyze the eubeequent lab work and explain how results will be used to evaluate the response to interventions.
Outline criteria and coneideratione for blood and transfusion therapy in this patient.