ABCDE and Sepsis Flashcards
A
- Is the patient alert and talking to you
- look, look feel, listen for airway obstruction
- medical emergency - oxygen, airway manoeuvres, suction, oro/nasopharygneal airway, bag and mask
B
- look - respiratory rate, cyanosis, accessory muscle, chest wall movement
- Feel - percussion, expansion, tracheal deviation
- Listen - lung fields
- Oxygen stats - aim for oxygen above 94%
- consider CXR, ABG, peak flow, nebulisers
C
- Assessment - pulse rate/rhythm, blood pressure, heart sounds, perfusion, capillary refill, JVP, oedema
- investigation and intervention - IV access, blood tests, IV fluids, 3/12 lead ECG, ACS
- IV fluid bolus = 500ml (130-154 mmol/L Na+) crystalloid/ <15 min
D
5 point disability check
- AVPU/GCS
- Pupils
- Lateralising neurology
- nick stiffness
- DEFG - don’t ever forget glucose
what does the patient respond to A- alert V- voice P - pain U - unresponsive
E
Expose the patient
- abdomen and focused neurology
- injury and haemorrhage
- joint/calves and for infection
- temperature and antibiotics
- history
what is sepsis
- life threatening organ dysfunction caused by a dysregulated host response to infection
How do you predict sepsis
- extremes of age
- recent trauma or invasive procedure
- impaired immunity.
- indwelling lines or catheters
- IV drug use
- breaches of skin integrity
- pregnant or recently pregnant
What are the high risk for patients with sepsis
- new altered mental state - objective
- RR greater than 25/min or new need for oxygen
- HR 130 BPM or above
- systolic BP <90mmHg or >40mmHg below baseline
- not passed urine in 18 hours
- mottled or ashen appearance
- cyanosis of skin, lips or tongue
- new non-blanching skin rash
what are the moderate risk factors for patient with sepsis
- new altered mental state - subjective
- RR - 21-24/min
- HR 91-130bpm or new arrhythmia
- systolic BP 91-100mmHg
- not passed urine in 12-18 hours
- tympanic temperature <36 degrees
- signs of infection at surgical site or wound
- history of acute function deterioration
- impaired immune system
- trauma or invasive procedure within 6 weeks
when should you do sepsis 6 management
- One high risk criteria
- Two moderate risk criteria and lactate
>2 mmol/L or AKI - SBP 91-100 mmHg
and lactate >2 or AKI
What is sepsis 6 management
- Oxygen: target saturations 94-98%
(88-92% in risk of hypercapnic respiratory failure) - IV fluid resuscitation
- IV antibiotics (within 1 hour)
- Cultures and Source control
- Blood lactate and blood tests
(Blood gas, FBC, CRP, U/Es + Creatinine, LFTs, Clotting screen) - Fluid balance (hourly)
what is the antimicrobial therapy that should be given to patients with suspected sepsis
- IV antibiotics within 1 hour
- blood cultures before antibiotics providing <45 min treatment delay
- broad spectrum antibiotics as trust policy if unclear source
- antivirals/antifungals to be considered
What are the indicators of organ dysfunction
- acute lung injury
- new altered GCS
- sepsis induced hypotension
- rise in bilirubin
- low platelets
- acute kidney injury
What volume resuscitation should you give in sepsis
Immediate IV fluids if SBP< 90mmHg or lactate >2mmol/L2
• IV crystalloid (130-154 mmol/L Na+) bolus 500ml in <15min2
• Up to 30ml/kg for hypotensive patients with frequent
reassessment3
When should you escalate a sepsis patient to critical care
- sepsis (or high risk) with systolic BP <90mmHg and/or lactate >4 mmol/L
What is septic shock
- sepsis with persisting hypotension despite adequate volume resuscitation (lactate >2mmol/L and vasopressor requirement)
what should you look for when assessing the limb
- including colour, temperature, and state of veins
what does low diastolic BP indicate
- indicates arterial vasodilation such as sepsis
What does a narrow pulse pressure indicate
- Narrow pulse pressure indicates arterial vasoconstriction (e.g. cariogenic or hypovolemic shock)
what does each colour mean in terms of the type of blood
- pink
- purple
- gold
- blue
- pink = group and save/x match as appropriate
- purple - FBC
- gold - U+Es, LFTs
- blue - coagulation
assume the patient is…
hypovolemic unless cardiogenic shock is suspected
What should you do if a patient has abnormal BP
if the patient has a normal BP give a fluid challenge which is a rapid infusion of 500ml of a warm crystalloid (if needed it can be repeated)
name the type of volume expanders that you can have
- crystalloid volume expanders
- colloid volume expanders
name the crystalloid volume expanders, what it is and what it does
- normal saline/hartmanns solution
- aqueous solution of mineral salts and water soluble molecules
- can cause harm-dilution
name the colloid volume expanders, what it is and what it does
- blood, albumin, plasma, gelofusine
- contains larger insoluble molecules such as gelatin
- maintains colloid osmotic pressure in the blood
What are the negatives of colloids
- expensive
- can cause coagulopathy
- anaphylactic reaction
- can precipitate cardiac failure
- can cause renal failure
What are the negatives of crystalloids
- dilute plasma proteins
- in cases of shock may result in hypoxia
- causes peripheral oedema
- potential for pulmonary oedema
