[frostfire]

Originally Posted by ender18d

Yes, this case meets the criteria for SIRS (Systemic Inflammatory Response Syndrome), which are two or more of the following:

> 38oC or < 36oC, heart rate
> 90 beats/minute, respiratory rate
> 20 breaths/minute or PaCO2 < 32
white blood cell count > 12,000 or < 4,000, or > 10% band forms.

SIRS isn't the diagnosis by itself, but an extremely important indicator of severity. Yes, this patient is seriously sick and hence the importance of starting treatment immediately in addition to evacuating him.

I think VD is a very good thought here as well, for two different reasons. First, bugs like neisseria gonorrhoeae can go systemic (usually going for joints rather than bone), and also immunocompromise would predispose the PT to development of an osteomyelitis via this mechanism.

Originally Posted by ender18d

Vitals: HR: 90, BP 130/85, RR 14, T 101.5deg

I was thinking SIRS all along with that vitals you posted. In the land of Airborne and SOF, I've noted that every single barrel-chested freedom fighter presented with bradycardia! Well, that's just their baseline of course. So when these types (just like our Team Sergeant pt here) presented with HR of 90, that's tachy for sure. Granted he's in pain, but still.

Toughness or stubborness (take your pick) can be problematic in the steely-eyed community. I remember treating this salty CWO4 SF who kept apologizing for showing up in the ER. He had long term steroid therapy for a previous condition, and ended up with pilonidal cyst that got to the point of both inner cheeks dripping with pus! It was the worst case I ever saw, thanks to 5 weeks wait from getting help.