NGN Case Study: Sepsis Walkthrough
Full 6-item unfolding case study on a septic patient. Worked from cue recognition through evaluation.
Unfolding case studies present a patient over 3-6 items. Each item maps to a clinical judgment step. Here's a sepsis case walked through end-to-end.
Initial presentation
65 y/o post-op day 2 after bowel resection. T 102.4°F, HR 118, BP 96/58, RR 24, SpO2 92% on RA. Foley with cloudy urine. Confused.
Item 1: recognize cues
Which findings require follow-up? Select: fever, tachycardia, hypotension, cloudy urine, confusion, hypoxia. Likely all, patient is septic.
Item 2: analyze cues
Most likely condition? Sepsis (most likely UTI source given foley and cloudy urine post-op).
Item 3: prioritize
Most concerning finding? Hypotension + altered mental status suggests progression to septic shock. Higher priority than fever alone.
Item 4: generate solutions
Which actions should be considered? Fluid resuscitation, broad-spectrum antibiotics, blood cultures, lactate, urine culture, vasopressors if needed.
Item 5: take action
Which to implement first? Hour-1 bundle: cultures (before antibiotics), antibiotics, fluid bolus 30 mL/kg, lactate.
Item 6: evaluate
Which finding indicates improvement? BP improves to 110/70, HR drops to 88, lactate trending down, mental status clearing, urine output >0.5 mL/kg/h.
Frequently asked
How long for a case study?
8-15 minutes total. Pace yourself.
Items linked?
Each scored independently. Wrong answer on item 1 doesn't bias scoring on item 2.
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