Box 73 Microbiological investigations in severe sepsis Initial tests

• Blood count, urea and electrolytes, liver tests, clotting screen, glucose, and CRP

• Repeated blood cultures, urine culture, chest x ray

• Serology and PCR tests (take advice)

Chest signs

• Sputum culture or bronchoscopy + lavage CNS signs

Abdominal signs, postabdominal surgery or no obvious cause of sepsis

• Abdominal ultrasound + CT

Heart murmur

• Echocardiogram

The most common radiological investigations include chest x ray film and abdominal CT scanning (Box 7.3). Laparotomy does not improve outcome in a critically ill patient in whom radiological examination has failed to show a surgically correctable problem.

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