Sepsis, Septic Shock and Multi-Organ Failure — WACS Viva & Clinical Scenarios (ICU & HDU)

Exam-style sepsis, septic shock and multi-organ failure viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 32-year-old male presents to the ICU 6 hours following emergency laparotomy for perforated typhoid enteritis. On admission, he is intubated, heart rate is 142 beats/min, blood pressure is 74/40 mmHg (mean arterial pressure 51 mmHg) on noradrenaline 0.35 mcg/kg/min, SpO₂ is 91% on FiO₂ 0.60, and arterial blood gas reveals pH 7.12, PaCO₂ 32 mmHg, PaO₂ 68 mmHg, HCO₃⁻ 10 mmol/L, base excess -16 mmol/L, and lactate 7.8 mmol/L. How will you systematically manage his refractory septic shock and severe metabolic acidosis over the next 6 hours in the ICU?
• SCENARIO 2: A 45-year-old female is admitted from the gynaecology ward 48 hours after an emergency hysterectomy for uterine perforation during an unsafe abortion. She is confused, tachypnoeic at 36 breaths/min, heart rate 130 beats/min, blood pressure 82/48 mmHg, and temperature 39.4°C. Laboratory results show white cell count 28,000/mm³, platelets 42,000/mm³, prothrombin time/INR 2.4, and creatinine 310 µmol/L. Detail your immediate anaesthetic and critical care resuscitation strategy.
• SCENARIO 3: A 60-year-old male with poorly controlled type 2 diabetes mellitus is admitted with extensive Fournier's gangrene extending to the anterior abdominal wall. He has undergone emergency surgical debridement and is transferred to the ICU mechanically ventilated, requiring noradrenaline 0.4 mcg/kg/min and adrenaline 0.15 mcg/kg/min to maintain a mean arterial pressure of 60 mmHg. His blood glucose is 24 mmol/L, potassium 5.9 mmol/L, and oliguria has developed (< 10 mL/h for 3 hours). What is your comprehensive ICU management plan for this patient?
• SCENARIO 4: A 28-year-old primigravida at 18 weeks gestation presents with acute pyelonephritis, high fever, and altered mental state, rapidly deteriorating into septic shock. Her blood pressure is 78/42 mmHg despite 2 litres of 0.9% saline, heart rate 138 beats/min, respiratory rate 32 breaths/min, and arterial lactate 5.4 mmol/L. Outline your step-by-step critical care management, addressing both maternal resuscitation and fetal considerations.