Management of unexpected acute postoperative sepsis in a case of wide local excision and skin grafting: a case report

Background: Sepsis is a major cause of morbidity and mortality in modern intensive care units (ICUs). Although several studies have provided epidemiological data on sepsis in ICU patients in the developed world [1–6],
Objective: To illustrate the need for early intervention and consultation for added assistance to approach and rule out other possible causes during such a scenario.
Case report: Patient presented with ulcer on posteromedial aspect of thigh since two years. Patient underwent uneventful wide local excision with skin grafting under general anaesthesia with epidural and extubated. Patient shifted to HDU for post operating monitoring. After 16 hours in post operative period patient had hypotension, fever, Difficulty in breathing. Patient intubated and put on ventilator. IV fluid bolus given but MAP not maintained > 65 mmHg. Pt was still hypotensive and start on ionotropic support with noradr. Further Vasopressin infusion also added. Fentanyl infusion started for sedation. Now pt was shifted to our ICU managed accordingly and shifted to ward on pod 4.
Conclusion: Early recognition of and treatment of sepsis can significantly reduce mortality. Limitations on resources make implementation of finding of clinical trails problematic. However, the most important interventions of aggressive fluid resuscitation, oxygen and early antiboitics, with frequent review to adjust treatment, can be achieved in any hospital.