I 100% get where you are coming from; however, in the ER setting, multiple non life threatening conditions could cause these symptoms (I assume paramedics don't get as much experience in in-hospital settings, please correct me if I am wrong as I am not from the US!)
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...
Ugh. This article hit me especially hard. I'm a medical student in my final year in a country where the last two years of our education consist of handling ER consultations for cases with a 'non-immediate risk of death'...
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.