This case involves a thirty-seven-year-old female who died of sepsis while being hospitalized for a skin infection. The woman presented to the emergency department with a red inflamed skin lesion on her leg which was diagnosed as cellulitis. Although antibiotics were initiated, the woman started to feel extremely ill. She began to experience a high fever accompanied by rapid breathing, confusion, and lower extremity swelling. They administered aspirin and a higher dose of antibiotics in an attempt to treat her condition. Forty-five minutes later, she developed severe hypotension and tachycardia which resulted in a loss of consciousness. A pulse could not be palpated on her. She was successfully resuscitated but lapsed into a coma thirty minutes later. The next day, the physician notified her family that she required life support and would not survive without it. The family decided to withdraw life support and the woman died shortly thereafter.
Question(s) For Expert Witness
1. Did this medical team address this patient’s symptoms properly, and what could have been done to prevent the death of this patient?
Expert Witness Response
This particular medical team failed to recognize the diagnosis of septic shock in a proper time interval. This patient progressed to a severe systemic inflammatory reaction in response to her cellulitis. Her infection spread to her bloodstream evidenced by the symptoms that she was experiencing. Patients who are in sepsis will typically experience rapid breathing, confusion, edema, flushed skin, and fever or hypothermia. Once this condition progresses to shock, the patient will have an increased heart rate and low blood pressure. This can rapidly result in death if not acted upon promptly. Death will occur as a result of acute respiratory distress syndrome (ARDS), encephalopathy, liver, kidney, and heart failure. In addition to antibiotics, this patient should have been initiated on intravenous fluids, mechanical ventilation, vasopressors. The patient might have also required a transfusion and hemodialysis.
About the author
Jason Cohn
Jason is a 4th year medical student pursuing a career in Otolaryngology/Facial Plastic Surgery. His Interest include sports, fitness, chemistry, otolaryngology, plastic surgery, allergy/immunology, surgical oncology, human genetics, public health, preventative medicine, and rheumatology.
