Step KL – Keep Looking

Physicians must be constantly vigilant towards source control. If the patient remains unstable or if new signs of infection appear – a new temperature, a rising white cell count, additional vasopressor therapy – the source is NOT controlled. It is too easy to ascribe persistent SIRS to an uncontrolled cytokine response. Intermittent chest radiographs, urinary cultures, blood cultures when the patient “spikes” a temperature are all useful methods of fishing for infection. Remember common things are common – a new infection is likely to come from the chest, the urinary tract or from lines. The abdomen should never be forgotten: beware of the surgical problem. Critical illness predisposes patients to a variety of other infections – acalculous cholecystitis, perforated peptic ulcers, missed diverticular ruptures, retained surgical dressings etc.


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