24 y/o male – difficulty breathing, dehydration

Inside the well kept home is a young man supine on the couch. He looks like I did when I was his age. Tall, lanky, and his hair just a tad too long for his mother's taste, but just right for his age. One look at him shows things are not right. He is moaning, and not the fake moaning of a drug seeker. His skin is very pale and he has goose bumps all over. He is VERY dry (skin, lips, tongue) and hot. My preceptor starts to get a history from the pt’s mother as I grab a set of vitals. Pulse 120, BP 72/48. Time to get moving.

Short version of his recent medical history: Our pt, usually a happy, healthy and active young man, had out-patient surgery five days before our being called. Day one after the surgery he started feeling worse instead of better. Over the next few days he spiked a fever, lost his appetite and could not keep down solids or liquids. His mother tried to get him to go to the hospital several times, but he kept telling her he was OK and didn’t want to go.

I knew the kid was particularly sick when my preceptor did not have me try and start a line. On the third attempt he got IV access with an 18 gauge. We got as much fluid in him as we could on our way to the hospital. When we left he was clearly in discomfort.

We stopped back a few hours later. The ER staff could not get another peripheral line in him, and had two failed attempts at a central line (they had called out for an anesthesiologist to try). They had pumped FIVE liters of fluids into him and his systolic BP didn’t get over 110.

Still later in the day he was being moved to ICU and they were considering dialysis as his kidneys (as well as other organs) were failing. Likely problem: sepsis.

As of now I don’t know how he is doing, but I can’t stop thinking about him and his family and fear the worst. We did everything we could and I worry it wasn't enough.

DJ