my spidey senses are a-tinglin'

lets play a game!!  we will call this game 'is this patient appropriate for the floor?'  ready?  ok!!

30 year old.  known source of infection with worsening cellulitis.  BP 82/47 after 4 liters of saline.  no urine output as of yet.

is this patient appropriate for the floor?  the answer is...

NO!!  this patient is septic!!  this patient needs an ICU bed!!  this patient is not quite in florid sepsis at the moment, but that pressure after that much fluid says to me that he is going to be quite soon.  and i said as much to the doctor, with little-to-no verbal filter as always.  i told him in no uncertain terms: this patient is unit-bound, and septic, and i am willing to bet money.  actual money!!

so the night nurse texts this morning with the latest set of vitals.

T:104.8
HR: 145
BP: 80/54
RR: 30

after 7.5 liters of fluids.

is this patient appropriate for the floor?  NO!!  did this patient go to the ICU?  YES!!  should doctors listen to nursing instinct?  YES!!  but i'm not going to say i told you so...

...ok i am.  which is rather generous on my part, because i think he should actually be giving me money.