PBL - emergency treatment and triage Flashcards
What is a NEWS2 score?
track and trigger system used to identify adult patients at risk of clinical deterioration
what makes up the NEWS2 score?
respiratory rate oxygen saturation temperature systolic BP heart rate level of consciousness
NEWS2 scoring
score of 0-3 is allocated to each physiological parameter
the magnitude of score reflects how extreme the parameter varies from norm
additional 2 points given for those requiring oxygen
total = 0-20
not diagnostic
oxygen saturation
scale 1 and scale 2
scale 1 oxygen saturation
target sats >96% and used for most patients
scale 2 oxygen saturation
target sats 88-92%
used for patients at risk of hypercapnic respiratory failure
e.g. COPD
interpreting NEWS score
aggregate score 0-4 = low risk, ward-based response
red score - score of 3 in any individual parameter = low-medium risk, urgent ward-based response
aggregate score 5-6 = medium risk, key threshold for urgent response
aggregate score 7 or more = high, urgent/emergency response
what causes hyperglycaemia?
type 1 or 2 diabetes stress flu and other illnesses similar type lack of exercise missing diabetic medication overtreatment of hypoglycaemia steroids diabetic ketoacidosis hyperosmolar hyperglycaemic state cushing's syndrome pancreatitis pancreatic cancer CF diuretics gestational diabetes surgery trauma
raised glucose in pneumonia
may help predict death
Raised lactate
type a, b1 or b2 or b3
type A raised lactate
inadequate oxygen delivery
anaerobic muscular activity
tissue hypoperfusion
reduced tissue oxygen delivery
type B raised lactate
no evidence of inadequate tissue oxygen delivery
B1 raised lactate
leukaemia lymphoma thiamine deficiency infection pancreatitis short bowel syndrome hepatic failure renal failure diabetic failure
B2 raised lactate
phenformin cyanide beta-agonists methanol adrenaline salicylates nitroprusside infusion ethanol intoxication in chronic alcoholics anti-retroviral drugs paracetamol salbutamol biguanides fructose sorbitol xylitol isoniazid lactate-based dialysate in RRT congenital forms with various enzyme defects
B3 raised lactate
associated with inborn errors of metabolism
causes of raised lactate
- increased in any condition that decreases the amount of oxygen available to body tissues
- any disease increasing lactate production
- any disease decreasing lactate removal – impaired hepatic metabolism
- strenuous exercise
- shock
- infections
- inherited metabolic disorders
- mitochondrial disorders
- certain medicines = metformin and isoniazid (TB)
- greater increase in lactate the greater severity of condition
- not diagnostic
- meningitis – suggests bacterial if raised
- sepsis
- heart attack
- congestive heart failure
- severe lung disease
- respiratory failure
- fluid build-up on lungs – pulmonary oedema
- severe anaemia
- liver disease
- kidney disease
- uncontrolled diabetes
- leukaemia
- AIDs
- deficiency in vitamin B1
initial triage measurements
temperature RR HR BP capillary refill time O2 saturations
normal RR
12-16
normal capillary refill
<2 seconds
normal O2 sats
95-100%
Airway
patency ability to vocalise dyspnoea secretions foreign body trauma
breathing
adequacy of breathing and gas exchange breathing rate chest wall movements use of accessory muscles breath sounds cyanosis tachycardia BP
circulation
function of CVS pulse quality and rate capillary refill time adequate blood volume skin colour temperature
disability
assess neurological system level of consciousness - GCS AVPU pupils physical or psychological problems identified assess pain
