A-E and Sepsis Flashcards
NEWS2 - what parameters are examined?
- respiration rate
- oxygen saturation
- systolic blood pressure
- pulse rate
- level of consciousness or new confusion*
- Temperature
*The patient has new-onset confusion, disorientation and/or agitation, where previously their mental state was normal – this may be subtle. The patient may respond to questions coherently, but there is some confusion, disorientation and/or agitation. This would score 3 or 4 on the GCS (rather than the normal 5 for verbal response), and scores 3 on the NEWS system.
If you are concerned about your pt based on NEWS2 score what can you do in UHL?
Remember - Contact Critical Care Outreach Team (CCOT) or the Out of Hours Response Team (OOHRT) via phone or bleep if you are concerned about your patient.
AVPU is now ACVPU… what does this mean?
NEW confusion
New confusion includes disorientation, delirium, and altered mental state
Is this ‘normal’ for your patient? ask relatives/carers if this is a change
Thinking of NEWS2 score, what score would indicate a clinical deterioration and prompt an urgent clinical response from a clinician?
i.e. think SEPSIS
A NEWS2 of 5 or above
https://www.rcpjournals.org/content/clinmedicine/22/6/514
NEWS2 - how many points are added to your score if you require 02?
2 points added if need supplementary 02
What is qSOFA? what score is this used for?
QUICK SOFA for Sepsis - used to predict mortality not to diagnose SEPSIS.
NEWS2 better at diagnosing / raising alarm of sepsis
What does qSOFA look at?
- Altered mental status GCS<15
- Resp rate >22
- Systolic BP <100
What qSOFA is high risk?
2-3 - increase in mortality. Assess for evidence of organ dysfunction and do full SOFA score
What does the SOFA score stand for? what does it dO?
Also another score APACHE II
Sequential Organ Failure Assessment (SOFA) Score
* Predicts ICU mortality based on lab results and clinical data to determine level of organ dysfunction.
What paraemeters does SOFA assess?
NOTE: Use the worse value in a 24 hours period
- Pa02 (kpa)
- Fi02 (% of inhaled 02)
- mechanical ventilation? (including CPAP) y/n
- Platelets (x103/ul)
- GCS
- Bilirubin (mg/dl)
- Mean arteral pressure or administration of vasoactive agents required
- Creatinine (mg/dl)
gives a score based on this of mortalitly prediction
What is SIRS? when does it become sepsis?
SIRS = Systemic inflammatory response syndrome (SIRS) is an exaggerated defense response of the body to a noxious stressor (infection, trauma, surgery, acute inflammation, ischemia or reperfusion, or malignancy, to name a few) to
SIRS with a suspected source of infection is termed sepsis.
https://www.ncbi.nlm.nih.gov/books/NBK547669/#:~:text=Even%20though%20the%20purpose%20is,of%20infection%20is%20termed%20sepsis.
SIRS, Sepsis, and Septic Shock Criteria
Will add picture
https://www.mdcalc.com/calc/1096/sirs-sepsis-septic-shock-criteria
UHL adult sepsis screening and Action tool:
will add picture
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