maternity sepsis

Question 1

risk factors for sepsis in maternity

Answer 1

1. diabetes or gestational diabetes
2. prolonged rupture of membranes
3. invasive procedures during pregnancy (c-section, forceps)
4. coming in contact with people with group A strep infections
5. ethnic minorities
6. Multiple pregnancy
7. continuous bleeding or offensive discharge
8. hx of fever or antibiotic

Question 2

commonest organisms during pregnancy

Answer 2

group a beta hemolytic strep and e coli. common source ante and intra partum is UTI, and chorioamniontis.
Post partum the uterus

Question 3

T or F

secondary bacterial infections to flu are a common source of sepsis in pregnancy and flu vaccine should be advised

Answer 3

T

Question 4

symptoms of sepsis in pregnancy

Answer 4

fever,pelvic pain, offensive vaginal discharge, diarrhea, rash which could be an early sign of Toxic shock, productive cough and urinary symptoms

Question 5

which patients groups are advised to have pneumococal vaccination

Answer 5

1. children and infants
2. older adults ( more than 65 years)
3. Asplenic patients or immunosuppressed
4. Those who are being treated for diabetes
5. chronic respiratory disease including severe asthma
6. chronic liver disease including cirrhosis
7. Chronic cardiac disease including heart failure
8. chronic kidney disease
9. those with cochlear implants

Question 6

True or False:

1. normal lactate levels exclude sepsis.
2. high lactate raises the possibility of septic shock

Answer 6

1. False

2. True

Question 7

what is Point of care testing for sepsis

Answer 7

1. lactate in suspected sepsis should be tested in secondary care
2. CRP can be used to guide the use of antibiotics in Lower respiratory tract infections without signs of pneumonia

Question 8

Which parameters are present in both NEWS2 and Qsofa for assessment of sepsis

Answer 8

mentation, respiratory rate and blood pressure

Question 9

what are the high risk criteria for sepsis in the elderly?

Answer 9

1. respiratory rate equal or more than 25
2. systolic BP less than 90 or more than 40 drop
3. new requirement of oxygen to keep saturation above 92 for patients and 88 for those with COPD
4. not having passed urine in the past 18 hours
5. objective evidence of new altered mental status
6. Pulse of more than 130

Question 10

Mention moderate risk criteria of sepsis in the elderly?

Answer 10

1. respiratory rate 21-24
2. blood pressure 91-100
3. not passed urine for 12 hours
4. family history of new altered behaviour or mental status
5. tympanic temperature less than 36
6. pulse 91-130 or new onset arrythmia

Question 11

What is CRB65?

Answer 11

1. confusion
2. respiratory rate more than or equal 30
3. BP less than 90 or diastolic less than or equal 60
4. age equal or more than 65

Question 12

True or false:

Unless a catheterised individual is acutely unwell with fever, empirical antibiotic should be avoided

Answer 12

true

Question 13

which vaccinations do you give the elderly and when?

Answer 13

1. influenza vaccine yearly after the age of 65
2. pneumococcal vaccine once at the age of 65. Those with chronic kidney disease stage 4,5, nephrotic syndrome, post transplant are given five yearly poosters. alongside asplenic patients and those with splenic dysfunction
3. shingles single dose at the age of 70
4. specific groups needing specific vaccines:
   - hib, men c, men b, men acwy for aspelnic patients and those with compliment dysfunction
   - hepatitis: those with chronic liver disease and hemophilia a and b
   - pneumococcal vaccine for those with cochlear implant