This case presents a clinical vignette of a 25-day-old infant brought to the ED with fever, lethargy, and poor feeding. The learner is provided an opportunity to develop their own diagnostic presentation and note, then compare it with an ideal standard. The case emphasizes the high-risk nature of febrile neonates and the importance of recognizing sepsis in this age group. A systematic approach is outlined, including the need for immediate attending notification, simultaneous history and physical exam, and initiation of a full septic workup (blood, urine, CSF) regardless of clinical appearance. The scenario illustrates the application of the American Academy of Pediatrics (AAP) guidelines, stressing early empiric antibiotic treatment and NICU admission. This case reinforces core principles in neonatal emergency care and the critical need for early intervention to prevent morbidity and mortality.

This case explores the evaluation and management of neutropenic fever in a 22-year-old female with lupus nephritis who recently received cyclophosphamide. The patient presents with nonspecific symptoms (fever, chills, and fatigue) but no focal signs of infection. Her profound neutropenia (ANC < 0.1) confirms a diagnosis of chemotherapy-induced neutropenic fever. In such immunocompromised patients, infections can progress rapidly without classic signs, necessitating urgent empiric antibiotic coverage. Learners will gain exposure to the diagnostic and therapeutic approach to neutropenic fever, including risk stratification, culture collection, and empiric treatment initiation. The case also highlights the importance of interdisciplinary collaboration with hematology and rheumatology to guide ongoing care and immunosuppressive management.

With advances in critical care technology, survival of acute critical illness has risen drastically, and many of these patients experience persistent deficits in physical and cognitive functioning, termed post-intensive care syndrome (PICS). This chapter provides a comprehensive overview of the pathophysiologic underpinnings of PICS. Perturbations during acute critical illness and early in recovery can have downstream and long-lasting effects. The immune response response is dysregulated with perturbations in both proinflammatory and immunosuppressive pathways. This dysregulation is more pronounced in patients who go on to have worse functional outcomes. Immune dysregulation also contributes to neuroinflammation, blood-brain barrier dysfunction, and disruptions in brain white matter leading to cognitive impairment. Transcriptomic analyses reveal massive shifts in gene expression, with aberrant expression of many genes related to the inflammatory response and extracellular matrix deposition, which clincially correlate with ICU-related complications, such as ICU-acquired weakness. Furthermore, sepsis and inflammation act together to disrupt the microvasculature, which further contributes to organ failure and ICU-acquired weakness. Mitochondrial dysfunction and ubiquitin-proteasome overactivation accelerate skeletal muscle catabolism and can also contribute to weakness. Finally, disruptions in the gut microbiome can disturb blood-brain barrier permeability and alter gene transcription associated with skeletal muscle growth and function. These perturbations interact deleteriously, resulting in the phenotype of PICS.

This chapter discusses care considerations for the immediate puerperium. This includes an overview of routine postnatal care for the mother’s physical and mental health, as well as important signs and symptoms of maternal and infant compromise. Common puerperal complications are described and risk factors, as well as management reviewed. Presentation and management of postnatal emergencies such as postpartum haemorrhage and haematomas, sepsis, venous thromboembolism and pulmonary embolus are discussed. Chronic postnatal complications including hypertension, problems of the lower urinary tract and pelvic organs, anaesthetic complications, wound breakdown, breast pain and anaemia are detailed, with a final section dedicated to mental health and the care of a woman presenting with a stillbirth.

Acute Illness and Maternal Collapse is an important chapter for all healthcare professionals involved in maternity services. This chapter reviews physiological changes of pregnancy and applies these principles to recognition of maternal illness. Specific conditions that contribute to poor maternal outcomes are outlined together with a systematic approach to assessment and management of an unwell mother, including management of maternal/obstetric cardiac arrest. This chapter should enable clinicians to develop well-rounded and patient-centred skills in the recognition, assessment and management of an unwell mother.

Vascular access is a fundamental skill in anaesthesia and intensive care, not only for drug administration but also for delivery of fluids and blood products, and for sampling for blood tests. Peripheral venous access is used for all patients undergoing surgery, but for major surgery and/or very unwell patients, central venous access and arterial access may also be required.

Flow rates through cannulae are key in determining the size of cannula chosen, and are proportional to the fourth power of their internal radius. All vascular access must be inserted aseptically, and removed if signs of infection develop. Serious complications, particularly after central venous access are well described including pneumothorax, haemothorax and cardiac tamponade. The use of ultrasound for facilitating access is mandated for central access, but is also increasing for both more difficult arterial and peripheral venous access.

Recognition and management of the sick patient outside of the operating theatre is often required by an anaesthetic trainee. There are a number of scoring systems in use, but the majority use the following parameters: respiration rate, oxygen saturation, systolic blood pressure, pulse rate, level of consciousness or new confusion and temperature. Values within the normal range score 0, and increase to 3 with progressively more abnormal (high or low) scores.

A number of clinical pictures may present with a sick patient but common scenarios encountered include haemorrhage and hypovolaemia, cardiac events (arrhythmias/myocardial infarction/failure), sepsis, pulmonary embolus and various iatrogenic problems ( e.g. pneumothorax, epidural problems, PCA overdose). Rapid diagnosis and management is essential. This will include blood tests, ABG, urinary catheter and often a urinary catheter. Patients may need imaging in the radiology department too, when stable.

Basic resuscitation involves ensuring delivering facemask oxygen, establishing reliable iv access and appropriate monitoring. This may include intravascular monitoring. Often iv fluids are required and should be guided by the monitoring available. Rapid treatment of sepsis is essential with appropriate antibiotics.

It is difficult to manage these patients on the ward and transfer to theatres/ICU is preferable.

Endomyometritis is a postpartum uterine infection that can lead to significant morbidity and mortality if not promptly recognized and managed. This case describes a 25-year-old primiparous patient with endometritis and how her condition was evaluated and managed. Endomyometritis is a clinical diagnosis. Key to the management is early introduction of antibiotics. If fevers persist, further evaluation is necessary to exclude alternative sources of infection. Early consideration of sepsis is crucial, and scoring systems can aid in identifying patients at risk for severe morbidity. Prevention strategies include reducing vaginal exams, minimizing the time between rupture of membranes and delivery, and implementing surgical bundles and prophylactic antibiotics for cesarean deliveries.

Organ dysfunction often occurs in the perioperative setting and in sepsis. Alterations in systemic hemodynamics may play a role, but even when these are within therapeutic goals, organ dysfunction may still occur. Microcirculatory alterations, a key determinant of tissue perfusion and of mitochondrial dysfunction, may play a role in the development of organ dysfunction. In this chapter, we discuss the evidence for alterations in microcirculatory and mitochondrial functions and their relevance, in circulatory failure and in the perioperative setting.

Infections cause direct maternal morbidity and remain a leading cause of maternal morbidity in the United States and globally. In this chapter, we will discuss the physiologic considerations of infectious diseases in pregnancy, alterations in pregnancy response to infections, changes in immune cell populations, and fetal immune response. Pregnancy is a state of relative immunosuppression order for the maternal “host” to not reject fetus and this immunosuppression has consequences in the setting of infectious illness. The pathophysiology, epidemiology, obstetric management, antibiotic therapy, and anesthetic management of the most frequent bacterial and viral infections in the obstetric patient including chorioamnionitis, sepsis, human immunodeficiency virus (HIV), group A streptococcus, and TORCH infections. Additionally, we will present the obstetric and anesthetic management of uncommon bacterial, viral, and parasitic infections. This chapter provides nuanced understanding of peripartum immunologic physiology, an overview of common obstetrical infections, and a quick resource for uncommon as well as tropical infections, such as tuberculosis and malaria as they relate to pregnancy for obstetrics anesthesia providers. Management pearls included in this chapter can improve maternal and fetal outcomes for pregnant patients with infections illnesses.

• Sepsis is currently defined as life-threatening organ dysfunction caused by dysregulated host response to infection. Septic shock is sepsis with persistent hypotension requiring vasopressor to maintain mean arterial pressure (MAP) ≥ 65 mmHg and having a serum lactate > 2 mmol/dL despite adequate fluid resuscitation.

There is wide variation in test characteristics for screening scores such as systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS). A qSOFA score of ≥ 2 or a change in SOFA score of ≥ 2 can promptly identify these patients; however, qSOFA is not recommended as a single screening tool over comparable scores such as SIRS, NEWS, or MEWS.

Shock is a pathological state resulting from inadequate delivery, increased demand or poor utilization of metabolic substrates (i.e., oxygen and glucose), which leads to cellular dysfunction and cell death. This then leads to progressive acidosis, endothelial dysfunction and inflammatory cascade that results in end-organ injury. Early in the course of shock, compensatory mechanisms may attempt to augment cardiac output (CO) and/or systemic vascular resistance (SVR) in an effort to improve tissue perfusion. Without treatment, those compensatory mechanisms are overwhelmed, leading to decompensated shock, multiorgan failure (MOF) and death.