Suriving sepsis - the first hour bundle
A 25yo trauma patient was hospitalized at the ward following a car crash. His injuries involve a fractured pelvis, humerus, four ribs and a pneumothorax, which was drained intermittently. Drain was extracted three days ago, control chest X-ray without pneumothorax. Humeral and pelvic osteosynthesis was performed, rib fractures were treated conservatively. During patient's post-operational recovery, there were no bleeding-related complications for seven days, hemoglobin and leukocytes were rising. Now the patient is somnolent, worn out and dyspneic. To raise his oxygenation you administer oxygen via a face mask. A likely diagnosis will be:
Examination
Patient is somnolent, short of breath, dypsnoic, shivers and coughing up a green-yellow dense sputum.
On auscultation, breathing is weakened on the right side, in the lower and middle lung field, diffuse bilaterally. Cardiac rythm regular, sounds without murmur, tachycardia.
Head, neck, abdomen, limbs without pathological finding.
