I think it's safe to say that our understanding of sepsis,including its recognition and management, have moved on alot since the tragic case of Jack. Jack could have had any number of initial differentials including gastroenteritis which is what his presenting features where.
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Replying to @BoyGeekDrone @Janine00050361 and
What I can’t get over is the degree of acidosis, hypoxia, peripheral shutdown and then raised Inflamatory markers and deranged U&E’s. With that blood gas and presenting features why wasn’t he safety netted to PICU or Consultant review?
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Replying to @doctorcaldwell @lynn_laidlaw and
I guess that's where consultant supervision plays a role. Also, she had treated him and I believe there was improvement biochemically and clinically which though fleeting, we know now, would have been falsely reassuring.
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Replying to @BoyGeekDrone @doctorcaldwell and
The repeat venous blood gas was an insufficient sample and not repeated. There was no ongoing obs, he developed profound hypoglycaemia, no one kept a fluid balance despite profuse D&V. Surely these are basics?
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Replying to @lynn_laidlaw @BoyGeekDrone and
I started as a Doctor in 1980 and I’m not sure I have ever seen a fluid balance chart in an acutely ill patient that I have believed. At least in the 1980s staff tried to add them up but these days it’s usually very murky and hard to work out what went in when and what came out
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Replying to @RobinaWilliams4 @doctorcaldwell and
My mother trained in the early 60s, and wasn’t allowed to go home until she had accounted for every teaspoon on the ward
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Replying to @LarcombePeter @RobinaWilliams4 and
As it should be, surely? I only worked in a building society in the 80s but we couldn't go home until every penny in the branch was accounted for - and nobody died if we screwed up. I guess I kind of expected at least that same degree of accuracy from medicine. Naively, perhaps.
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Replying to @C7RKY @RobinaWilliams4 and
The point is that acute medicine has evolved so far and so fast that no one warrants a hospital bed if they’re capable of wielding a teaspoon, and nurses have vastly more complex things to occupy their time than cutlery.
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I had one eye on the fluid charts when I was saying that, rather than the teaspoons tbh... but your point is well made nonetheless.
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