Analysing the treatment and care given

There was a need to:

• Get support and escalate care early: The initial review that was taken by the junior doctor could have included the registrar but, regardless, an assessment using the NICE criteria should trigger the need for escalation of treatment and care.
• Ongoing monitoring: Observations need to be assessed and recorded hourly as 's blood pressure starts to deteriorate. This deterioration should trigger the guidelines in an early warning system. To escalate information to senior medical staff.
• Lactate level assessment: Assessing a lactate regularly is important as it highlights the potential deterioration in the patient's status.
• Fluids and hydration: Maintaining the hydration levels requires fluid resuscitation and assessment of urine output. Consideration of the need to catheterise could have been earlier to monitor urine output but this was a rapidly changing situation and had been incontinent in the ED suggesting urine output at that point was adequate
• Infection screening: Taking 2 sets of blood cultures (as per local policy guidelines) in addition to the other blood tests is essential. As the full examination progresses, there is a need to ensure all wounds and potential areas of infection (e.g. cellulitis) are fully assessed. All specimens taken and sent need to be reviewed. It is the responsibility of the person taking the specimen/blood, to ensure that the result is analysed.
• Antibiotic therapy: Whilst the tazocin was given within the first hour of recognition of potential infection, it is important to ensure that antibiotics are not given inappropriately and are reviewed regularly.
• Oxygen therapy: Adding in high flow oxygen should be considered but titrated to keep the SpO₂ level between 92% and 98% particularly where the patient potentially has a degree of COPD.