many derangements can indicate infection:
Maximum in comparison to last 24/hours/few days
Trends: coming down?
Daily spike? --Abscess or localized infection can cause spikes.
Poor oxygenation?
Acidosis? Occurs with sepsis.
Tachycardia and hypotension in sepsis.
increased WBC count, left shift= neutrophilia=High PMNs.
Check all cultures daily and sensitivities to direct therapy.
Daily chest xray study-new infiltrates, new effusion, edema?
CT abdomen. Abscess? Phlegmon?
V/Q scan-possible PE.
Rales, ronchi.?
Abdominal pain?
Ascites?
Central/peripheral lines sites? erythema, cellulitis.
Incision? erythema, cellulitis.
Bowel sounds? present, absent, hyperactive.
"Patient is febrile with Tmax of 102 F, ABG shows a mild acidosis, continues to have rales at bilateral bases, a recent WBC of 16(yesterdays was 25) with 80 PMNs. Today's chest xray does not show improvement since yesterday's."
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