orthozato
That said, there was a cascade of errors that ultimately led to this very very unfortunate outcome (that maybe could have been prevented, or maybe not)
Had the chest x-ray been ordered perhaps his enlarged heart could have been noticed in due time.
I do not mean to be pretentious in any way. I hope my english does not interfere with this.
Let's do a chronological analysis of some prior definitions of sepsis.
The first one, from the 1990s, utilized an elevated white blood cell count plus three clinical variables (temperature, heart rate, and respiratory rate). This definition is very broad; statistically speaking, it's very sensitive but has low specificity.
The most recent definition describes sepsis as 'life-threatening organ dysfunction caused by a dysregulated host response to infection.' Septic shock is defined as a subset of sepsis in patients who have a vasopressor requirement and a lactate level greater than 2 mmol/L.
Scores such as NEWS, SOFA, and qSOFA exist, but they primarily assess disease severity and prognosis for patients who are already in a hospital setting.
It is very important to always maintain a high degree of suspicion for sepsis, but it seems to me that few clinicians would have had a strong suspicion of it in this case...
It is quite tricky and this Shakespeare reference might be a little bit out of context...