Critically unwell surgical patient Flashcards
What does 2 or more of these symptoms indicate?
- Temp >38°C (100.4°F) or < 36°C (96.8°F)
- Heart Rate > 90
- Respiratory Rate > 20 or PaCO2 < 32 mm Hg
- WBC > 12,000/mm3, < 4,000/mm3
SIRS
systemic inflammatory response syndrome
(a cause of shock e.g. acute circulatory failure with inadequate tissue perfusion causing cellular hypoxia)
What is sepsis?
SIRS (systemic inflammatory response syndrome) + source of infection
What does this describe?
- organ dysfunction, hypotension, or hypoperfusion.
- Lactic Acidosis,
- SBP <90 or SBP Drop ≥ 40 mm Hg of normal
Severe sepsis
What is septic shock?
Septic shock = severe sepsis with hypotension, despite adequate fluid resuscitation
rememebring sepsis = SIRS (systemic inflammaotry response syndrome) + source of infection
What is multiple organ dysfunction syndrome?
evidence of >2 organs failing
What is the sepsis 6?
Rx for sepsis?
Take: Abg (lactate), cultures, UO
Give: oxygen, fluid challenge, abx
best guess abx –> @sgul = co-amoxiclav & gentamicin
- Change therapy based on cultures
- Physiotherapy
- ITU
- Surgery
- Interventional radiology
What is the equation for BP?
BP = CO x TPR [HR x SV (CO) x TPR}
What causes of hypotension are there?
- Hypovolaemia
- cardiogenic
- obstructive
- vasodilatory state
What cause of hypotension are these?
- PE
- Tamponade
- Tension pneumothorax
Obstructive hypotension
What causes of hypotension are these?
- Blood loss
- Plasma loss
- Saline loss
- Dehydration
Hypovolaemia
CO x TPR [HR x SV x TPR]
What causes of hypotension are these?
- MyocardiaI infarction
- Cardiac failure
- Myocardial contusion
- Arrhythmia
Cardiogenic
BP =CO x TPR [HR x SV x TPR] e.g. cardiogenic = decreased CO
What causes of hypotension are these?
- Sepsis
- Neurogenic
- Trauma & transection of spinal cord
- Epidural
- Anaphylaxis
- Adrenal insufficiency (LT steroids)
Vasodilatory state
e.g. BP: CO x TPR [HR x SV x TPR]
What can happens if you have hypotension in the body?
HYPOTENSION + HYPOXAEMIA = ARREST
:(
What should be given in these circumstances?
- Poor UO - 10ml/kg
- Low BP - 20ml/kg
- HF & poor UO - 5ml/kg
= Fluid challenge!
- Poor UO - 10ml/kg
- Low BP - 20ml/kg
- HF & poor UO - 5ml/kg
What happens to the bodys fluid in surgery?
Surgical insult and metabolic stress –> RAAS activated –> Na retention
BUT surgery also involved many losses of fluid –> NG aspirates, ileostomy & fistula outputs, diarrhoea, ileus, sweat
