Homlessness Flashcards
What are the essential assessment?
A to E
What was Bills’s A assessment?
- Verbalising intermittently
- No foreign objects in mouth or excessive secretion
- No snoring/stridor
- No mouth or tongue swelling
What was Bill’s B assessment?
- Respiratory rate - 14 breathes per minute
- Oxygen saturation - 90% initially, after 2L oxygen 94%
- No evidence of respiratory distress
- Mild Wheeze
- Smoker
What was Bill’s C assessment?
- Blood pressure - 89/64 mm Hg
- Heart rate - 110bpm regular
- Heart sounds - normal
- 12 lead ECG - sinus tachycardia, nil ischaemic changes
- Peripheral capillary refill brisk bilaterally (>2sec)
- Warm peripheries, look flushed
What are the different types of shock?
- Hypovolemic
- Cardiogenic
- Obstructive
- Distributive
What are the different types of distributive shock?
- Septic
- Anaphylatic
- Neurogenic
What is Bill’s D assessment?
- Blood glucose - 5.7
- Temperature - 38. 2
- Confused (ACVPU) / GCS E3 V4 M5
- Moving 4 limbs normally
- PEARL-3mm
- Smells of alcohol
What is Bill’s E assessment?
- No rashes
- No sites of injection / track marks
- No evidence trauma to limb or head
- No evidence of external bleeding
- Abdominal examination - abdomen distended, tender in left illiac fossa
What is the initial impression?
- Sepsis
- Altered mental state - likely due to sepsis however need to consider alcohol, delirium, drugs and intra cranial pathology
What is the initial plan?
- Sepsis management
- Need to investigate source of sepsis
- CT head to rile out intra cranial pathology
Why could it be sepsis?
- Warm peripheries suggest sepsis
- Cerebral hyperperfusion
- Low BP
- Homeless & was living in a homeless shelter has had frequent infections previously → infection → sepsis
- Has piercings which could suggest infection
- He could have ingested something because his abdomen was distended, slight wheezing etc. - GI tract issues?
- Temperature increased to 38.2 degrees which could suggest sepsis
What is SIRS?
- More than 2 of:
1. Temperature above 38 or below 36
2. Heart rate more than 90 bpm
3. Respiratory rate more than 20
4. WBC count >12x10^9/ L or <4x10^9/L
What is sepsis? What should you do?
- Meets SIRS criteria with evidence of infection
- Blood cultures
What is severe sepsis? What should you do?
- Sepsis with evidence of organ dysfunction, hypotension or hypo-perfusion
- Lactate, urine output
What is septic shock?
Severe sepsis with hypotension despite adequate. fluid resuscitation
What is the sepsis 6?
- Give O2 to keep SATS above 94%
- Take blood cultures
- Give IV antibiotics
- Give a fluid challenge
- Measure Lactate
- Measure urine output
What tests does the doctor order?
- Biochemistry
- Haematology
- Toxicology
- Blood culture
What biochemistry test does the doctor order?
- CRP
- Creatinine
- Urea
- Na
- K
- ALT
- ALP
- GGT
- Bili
- Amylase
- Lactate
What haematology tests does the doctor order>
- Hb
- WCC
- Neut
- PLT
What is the clinical update?
- CT normal
- Blood tests are keeping with sepsis
- Blood cultures sent, IV antibiotic given
- Patient improving clinically with IV antibiotics + IV fluid
- Patient now less confused, reporting severe pain in abdomen
- On examination - patient tender in left illiac fossa, abdomen soft to palpation
What is the plan?
- Analgesia
- CT abdomen/pelvis
- Continue IV fluids and antibiotics
What was his NEWS score?
3 does not require escalation
Which area of colon is most likely affected?
Sigmoid colon / desending colon - but still possible referred pain from other organs (for review of results look at report)
How many quadrants are in the abdomen?
4
How many regions are in the abdomen?
9
What is the perineum considered as?
10th division (the area beneath the hypogastric region at the bottom of the pelvic cavity)
What is the right upper quadrant?
- Right portion of the liver
- Gallbladder
- Right kidney
- Small portion of the stomach
- Duodenum
- Head of the pancreas
- Portions of the ascending and transverse colon
- Parts of small intestine
What is pain in the right upper quadrant associated with?
infection and inflammation in the gallbladder and liver or peptic ulcers in the stomach
What is the left upper quadrant?
- Left portion of the liver
- Part of the stomach
- Pancreas
- Left kidney, spleen
- Portions of the transverse and descending colon
- Parts of the small intestine
What is pain in the left upper quadrant associated with?
malrotation of the intestine and colon
What is the right lower quadrant?
- Cecum
- Appendix
- Part of the small intestines
- Right half of the female reproductive system
- Right ureter
What is pain in the right lower quadrant associated with?
appendicitis
What is the left lower quadrant?
- majority of the small intestine
- some of the large intestine
- left half of the female reproductive system
- left ureter
What is pain in the left lower quadrant associated with?
- colitis (inflammation of the large intestine)
- pelvic inflammatory disease -ovarian cysts in females
How are the quadrant defined?
by the intersection of the sagittal plane with the umbilical plane (the transverse plane through the navel)
How are the nine divisions marked?
by two parasagittal and two transverse planes centered around the navel
What is the right hypochondriac division?
- right portion of the liver
- Gallbladder
- Right kidney
- Parts of the small intestine
What is the left hypochondriac division?
- Part of the spleen
- Left kidney
- Part of the stomach
- Pancreas
- Parts of the colon
What is the epigastric region?
- Majority of the stomach, part of the liver
- Part of the pancreas
- Part of the duodenum
- Part of the spleen
- The adrenal glands
What is different about the epigastric region?
This region pushes out when the diaphragm contracts during breathing
What is the right lumbar region?
- Gallbladder
- Left kidney
- Part of the liver
- The ascending colon.
What is the left lumbar region?
- descending colon
- left kidney
- Part of the spleen
What is umbilical region?
- umbilicus (navel)
- duodenum
- jejunum
- illeum.
- transverse colon (the section between the ascending and descending colons)
- bottom portions of both the left and right kidney.
What is the right illiac region?
- Appendix
- Cecum
- Right iliac fossa
- commonly referred to as the right inguinal region
- Pain in this area is generally associated with appendicitis.
What is left illiac region?
- Descending colon
- Sigmoid colon,
- Left illiac fossa
- commonly called the left inguinal region
What is the hypogastric region?
- bladder
- part of the sigmoid colon
- anus
- many organs of the reproductive system, such as the uterus and ovaries in females and the prostate in males.
What is a diverticulum?
a small pouch with a narrow neck that sticks out from (protrudes from) the wall of the gut (intestine)
What is diverticula?
more than one diverticulum
Where do diverticula develp?
any part of the gut but usually occur in the colon (LI) - near rectum
How common are diverticula?
1/2 have diverticula by 50 and 7/10 by 80, increasing with age
Why do diverticula happen?
High pressure develops pushing inner of a small area of your guy through the muscle wall to form a small diverticulum: high fibre diet
Is diverticulosis painful?
3/4 with diverticulosis - no symptoms 3/4 with diverticula no harm or symptoms
What happens in diverticular disease?
cause intermittent abdominal pain or bloating - crampy comes and go
Diarrhoea or constipation similar with IBS symptoms but IBS in younger people but hard to tell (symptoms also similar for early bowel cancer)
What is diverticulitis?
- one or more of the diverticula become inflamed and infected, if faeces get trapped and stagnate in a diverticulum, bacteria may multiply
- 1 in 5 with diverticula have bout of diverticulosis
What are the symptoms of diverticulitis?
- A constant pain in the abdomen
- most commonly in the lower left side of the abdomen, but can occur in any part of the abdomen
- Indeed, in people of Asian origin, it sometimes occurs on the right side. - High temperature (fever).
- Constipation or diarrhoea.
- Some blood mixed with your stools.
- Feeling sick (nauseated) or being sick (vomiting)
What are the complication of diverticulitis?
- A blockage (obstruction) of the colon.
- Acollection of pus (abscess)that may form in the abdomen.
- A channel (fistula) that may form to other organs such as the bladder.
- A hole (perforation) in the wall of the bowel that can lead to infection inside the abdomen (peritonitis).
- Surgery is usually needed to treat these serious but uncommon complications
Can you bleed with diverticulitis?
May bleed and blood to anus, abrupt and painless due to burst blood vessel, large bleed requires transfusion but bleeding stops on its own in 3/4 cases
How much fibre do you need?
18-30 g of fibre per day (20-35)
How should you reduce symptoms?
- if lose weight if overweight or obese
- exercise
- stop smoking
What are some high fibre foods?
- Whole grains, fruit and vegetables.
- Wholemeal or wholewheat bread and flour (for baking).
- Wholegrain breakfast cereals such as All-Bran®, Weetabix®, muesli, etc.
- Brown rice and wholewheat pasta.
- Wheat bran.
- Beans, pulses and legumes
What medicine should you take?
- 2L of water, paracetamol ok but NSIAIDs and opiod medicine avoided as can cause perforation
- Your doctor may prescribeantispasmodicssuch asmebeverineif you have persistent abdominal spasms
How do you treat diverticulitis?
Antibiotics, or prolonged admitted to hospital or surgery for complication
How do you diagnose diverticulitis?
sigmoiooscopy usually incidental finding or colonoscopy or from CT or barium X rays
Can you get fibre substitutes?
- As an alternative, your doctor may recommend a supplemental fiber product such as psyllium, methylcellulose or polycarbophil
- These products come in various forms including pills, powders, and wafers
- Supplemental fiber products help to bulk up and soften stool, which makes bowel movements easier to pass
- Your doctor may also prescribe medications to help relax spasms in the colon that cause abdominal cramping or discomfort
