General Flashcards
Define sepsis?
SIRS criteria?
Septic shock?
An infection that triggers a systemic inflammatory response syndrome.
SIRS criteria?
- Body temp outside of 36-38degrees
- HR > 90 beats/min
- RR > 20/ min
- WBC > 12000/mm3 or < 4000/mm3
- -> infection + >2 elements of SIRS = sepsis
- -> organ failure = severe sepsis
- -> hypotension = septic shock
Key features of hemorrhagic shock (5)?
Starts to get symptomatic if blood loss >750ml:
- reduced blood pressure,
- reduced urine output,
- increased HR
- increased RR
- confused
Most likely the result from trauma
What is cardiogenic shock?
Cause?
Ix?
Tx?
Poor circulation of the blood due to poor ventricular function –>
- low urine output
- cool arms and legs
- altered consciousness
Main cause is IHD/ trauma
Ix: transthoracic echo to see pericardial fluid and direct myocardial injury
tx =
- fluids/ inotropes
- intra-aortic balloon pump
- heart transplant
What are the different types of shock (5)?
- septic shock
- haemorrhagic shock
- cardiogenic shock
- anaphylactic shock
- neurogenic shock - spinal cord injury/ epidural/ spinal anesthesia
- hypotension, bradycardia, warm extremities
- Tx NA/ vasopressin (increase peripheral vascular resistance) + atropine (bradycardia)
What are the different pulses (5)?
- Pulsus parodoxus = bp falls during inspiration
- e.g. severe asthma, cardiac tamponade - Collapsing
- e.g. aortic regurg - Pulsus alternans = alternation of force of arterial pulse
- e.g. LVF - Jerky pulse
- e.g. HOCM - slow rising
- e.g. aortic stenosis
What advice would you give to diabetics when they’re ill (3)?
- Keep taking oral hypoglycaemics as body releases cortisol when ill –> increased bgl (except metformin if they’re dehydrated as can lead to renal failure)
- monitor bgl regularly
- try to drink at least 3L water per day and if can’t eat then drink sugary drinks
what type of feeding is contraindicated in patients with base of skull fracture?
NG feeding
How much adrenalin do you give patients in anaphylaxis?
< 6yo = 150 micrograms (0.15ml of 1 in 1000)
6-12yo = 300 micrograms
> 12yo = 500 micrograms
What does prothrombin concentrates contain?
When is it given?
factors 2, 7, 8 , 9
Given when patient is on warfarin and INR is > 8
Indications for CT head immediately (5)?
- GCS < 13 on initial assessment/ GCS < 15 at 2 hours post-injury
- suspected open or depressed skull fracture. any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
- post-traumatic seizure.
- focal neurological deficit -weakness/ blown pupil
- more than 1 episode of vomiting
Indications for CT head within 8 hours (4)?
- age 65 years or older
- any history of bleeding or clotting disorders
- dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
- more than 30 minutes’ retrograde amnesia of events immediately before the head injury
- on warfarin
What is step 4 of HTN management if patients bp is still not controlled?
Hypertension - step 4
K+ < 4.5 then spironolactone
K+ > 4.5 then higher-dose thiazide-like diuretic
What is spinal shock?
spinal cord transection -> hypotonic paralysis, bladder retention, areflexia, loss of sensation
