Bill - Emergency

Question 1

What is meant by circulatory shock?

Answer 1

Circulatory shock - used when inadequate blood flow results to damage to body tissues

Question 2

What are the 4 types of circulatory shock and explain briefly what causes each of them?

Answer 2

Hypovolemic - loss of blood volume
Obstructive - physical obstruction to blood flow
Cardiogenic - due to ventricular failure
Distributive - due to vasodilation (Due to sepsis, anaphylaxis, neurogenic effects)

Question 3

If the patient has warm peripheries, what is causing low BP

Answer 3

Vasodilation of the peripheries

Question 4

What is a symptoms sieve?

Answer 4

Symptom sieve is used to get broad categories explaining pathological processes behind a condition

Question 5

What is the A-E assessment?

Answer 5

Airways
Breathing
Circulation
Disability
Exposure

Question 6

Why is altered mental state considered a sign of sepsis?

Answer 6

Circulatory shock leads to low BP, which leads to histamine and cytokine release which then leads to vasodilation which results in decreased cerebral perfusion

Question 7

What is a renal sign of hypoperfusion

Answer 7

low urine output as kidneys are not receiving enough blood

Question 8

What are 2 other signs of hypoperfusion

Answer 8

Mottled skin and tachycardia also shows hypoperfusion

Question 9

What is the diagnosis criteria for SIRS?

Answer 9

SIRS

≥2 of

Temp >38 or <36 (elderly)

Heart rate >90bpm

Resp rate >20

First sign of deterioration is tachypneoa

WBC Count >12x10^9 or <4x10^9/L

Question 10

Other than meeting criteria for SIRS, what else is required for a sepsis diagnosis?

Answer 10

SEPSIS
Meets SIRS criteria and evidence of infection
Blood cultures

Question 11

What is needed to diagnose a patient with severe sepsis?

Answer 11

• Sepsis with evidence of organ dysfunction, hypotension or hypoperfusion
• Lactate,
• Urine output

Question 12

If you suspect sepsis, you are supposed to do the Sepsis 6, what are these?

Answer 12

1) Give Oxygen to keep stats above 94%
2) Take blood cultures - sign of sepsis
3) Give IV Abx - if you suspect sepsis then give Abx within an hour
4) Give a fluid challenge - give a bit of fluid fast 250-500ml of crystalline solution within 15 mins (stat)
5) Measure lactate - sign of hypoperfusion
6) Measure urine output - sign of hypoperfusion