Author: Alexander Nelson / Editor: Steve Corry-Bass / Codes: DC5, RP7, SLO3 / Published: 06/01/2025
A 22-year-old is transferred to a specialist plastics review. The ambulance crew who are transporting them are concerned that they are unwell and pre-alert you in resus. You and the plastics team agree to see the patient together.
One week earlier the patient cut their finger while working in a bar. It was closed on the day of the injury at the local Emergency Department (ED). They then re-presented concerned of an infection and were discharged with antibiotics (Co-amoxiclav). They are on day 5 of this course. Today they have re-presented to their local ED with flu like illness, feeling generally unwell with ongoing fevers. Plastics were consulted and they accepted the patient for further assessment and management. They have no past medical history and no allergies.
On arrival in resus the patient looks unwell. They are maintaining their own airway, saturating well on room air with slight increase in respiratory rate but no added sounds. They are tachycardic and hypotensive though warm peripherally, the patient appears flushed and has a generalized erythematous rash. They are alert, orientated and able to follow commands. They are febrile.
The wound on the index finger is small but appears infected. There is no spreading erythema and no significant swelling, blisters or crepitus.
You initiate the ‘sepsis 6’, including fluid resuscitation and broaden the antibiotics. The plastic surgery team are preparing to debride the wound.