A 56 year old teacher with a significant history of hypertension and well-controlled diabetes presents to the emergency room (in the U.S.) with a five day history of fever, productive cough, and progressive dyspnea. At presentation he is febrile to 103.2 F, has a blood pressure of 102/66, pulse of 135 beats per minute, respiratory rate of 33/min, and is satting 84% on room air, which improves to 93% on 4L nasal cannula. Labs show a leukocytosis of 18,000, lactate on 1.8, and a bicarbonate of 19 with a gap of 14, and is positive for influenza A. A chest x ray shows a possible left lower lobe infiltrate. He is given 1L of NS, started on ceftriaxone and doxycycline, and is admitted to the medical floor. Overnight he decompensates, with a oxygen desaturation to 72% on 4L, an ABG showing a pH of 7.21 and a PaO2 of 45 mmHg. A rapid response is called and he undergoes RSI with propofol and is transferred to the MICU. His blood pressure is now 70/42 mmHg with a MAP of 51. He is given a 2L bolus of NS without a significant hemodynamic response. A central line is placed and the repeat chest x ray shows worsening bilateral opacities. Antibiotics are broadened to vancomycin plus piperacillin/tazobactam and norepinephrine has been titrated up to a rate of 24 ug/minute. Repeat labs show a rising creatinine at 3.1 mg/dL, a troponin T of 1.2 ng/mL, and a lactate of 5.2 mmol/L.
It’s been 7 hours since pressors were initiated, at this point, would you or would you not administer corticosteroids? If so, at what dose, administration, and duration?
Easy one-click social registrationIs this safe?
We only receive the minimum information necessary to verify your account. We never get access to your friends/contacts or your profile, and we never post on your behalf. Your social account is used for logging in only.ORRegister via email
Send me updates on this Contest
In order to ensure a fair voting process and to make sure that no one votes more than once, we ask that you register either with a social networking account (easiest, only requires one click) or by registering with your email address (this will require you to click on a verification email that we will send you).
You only need to register once.