Spotlight: Overdiagnosis and Delay: Challenges in Sepsis Diagnosis | AHRQ Patient Safety Network

Spotlight: Overdiagnosis and Delay: Challenges in Sepsis Diagnosis | AHRQ Patient Safety Network

Spotlight: Overdiagnosis and Delay: Challenges in Sepsis Diagnosis

• SPOTLIGHT CASE
• CE/MOC

Ifedayo Kuye, MD, MBA, and Chanu Rhee, MD, MPH; October 2018

Admitted with generalized weakness, nausea, and low blood pressure, an elderly man was given IV fluids and broad spectrum antibiotics. Laboratory test results revealed a mildly elevated white count, acute kidney injury, and elevated liver function tests. The patient was admitted to the medical ICU with a presumed diagnosis of septic shock. His blood pressure continued to trend downward. While reviewing the emergency department test results, the ICU resident noticed the patient's troponin level was markedly elevated and his initial ECG revealed T-wave inversions. A repeat ECG in the ICU showed obvious ST segment elevations, diagnostic of an acute myocardial infarction. The resident realized that the patient's low blood pressure was likely due to the myocardial infarction, not septic shock. He underwent urgent cardiac catheterization and was found to have complete occlusion of the right coronary artery, for which a stent was placed.