Sepsis Flashcards
What are some causes of altered mental health?
- toxins (i.e. alcohol, drugs)
- infections
- psychiatric
- metabolic/ endocrine (i.e. hypoglycaemia)
- G.I
- primary neurological
What approach is used on a patient in A&E?
ABCDE approach
What does A stand for and when do we know that airways are definitely open?
Airway -> if they can speak
What can cause negative airway signs?
- decreased GCS (<8/15)
- excessive secretions
- foreign bodies
- airway swelling
- trauma
How can you assess the airway?
- look at chest/ abdomen movements
- listen for noises (partial obstruction) or absent noises (total obstructions)
How can you treat obstructions?
- head tilt and chin lift, or jaw thrust
- suction to remove debris; basic airway adjuncts
- interventions (tracheostomy)
OXYGEN THERAPY MUST BE GIVEN.
What is B and what can cause B problems?
Breathing. Causes include…
- decreased GCS
- asthma
- COPD
- pneumonia
- pneumothorax
- PE
How is breathing assessed?
- paO2
- RR
- ability to talk in full sentences/ words
- central cyanosis
- symmetry of chest
- tracheal deviation
- percussion + auscultation of chest
How can you treat breathing problems?
specific to cause but sit patient up if dyspnoeic
GIVE OXYGEN
What is C and what can problems in C cause?
circulation -> circulatory shock (inadequate blood flow which results in damage to body tissues)
What are the different types of shock?
- hypovolaemic (due to loss in blood volume)
- cardiogenic (due to heart pump failure)
- distributive (causes vasodilation)
- obstructive shock
What are some causes of cardiogenic shock?
- heart failure
- MI
- arrythmia
What are some causes of obstructive shock?
- cardiac tamponade (fluid in pericardial sac due to trauma)
- tension pneumothorax
- PE
What are the 3 main categories of distributive shock?
- septic (infection causes release of cytokines + histamines -> vasodilation)
- anaphlyactic (histamine release)
- neurogenic (damage to spinal cord)
How is circulation assessed?
- colour of extremities
- capillary refill time
- HR
- ECG
- pulse palpation
- BP
- auscultation of the heart
- look for bleeding
How are circulation problems treated?
- insert cannulae
- fluid challenge if low BP
- blood transfusions
What does D stand for and what do you assess?
Disability You assess... - GLUCOSE - temperature - ACVPU/ GCS - pupil response - pain - check drug charts
What are some problems that can cause a change in disability?
- hypoxia/ hypercapnoea
- drugs
- stroke
- raised ICP
- cerebral hypoperfusion
- metabolic dysfunction (i.e. hypoglycaemia)
What is E?
Exposure -> take history, and examine thoroughly. Review reports
What can you look for in E?
- rashes
- track marks caused by drug use
- trauma
- cuts/ bleeding
What are the signs of hypoperfusion of tissues (caused by hypotension)?
- altered mental health
- mottled/ clammy skin
- oliguria (low urine output)
- tachycardia (compensation)
- elevated lactate
Who is at risk of septic shock?
Those with…
- hypoxia
- hypotension
- delirium
- tachycardia
Describe the spectrum of sepsis.
- SIRS
- Sepsis
- Severe sepsis
- Septic shock
What is 1) SIRS?
Systemic Inflammatory Response Syndrome
How do you diagnose someone with SIRS?
They need to have ≥ 2 of these symptoms:
- high temperature (>38 or <36)
- high HR (>90bpm)
- abnormal WBC count
How is sepsis diagnosed?
- SIRS criteria is met
- evidence of infection (blood cultures)
How is severe sepsis diagnosed?
- Sepsis with evidence of end organ hypoperfusion/ dysfunction (check lactate + urine output)
How is septic shock diagnosed?
Severe sepsis with hypotension despite fluid resuscitation
What is the sepsis 6?
x3 TAKE - blood cultures - lactate in ABG - urine output x3 GIVE - O2 -> keep sats ≥94% - IV Abx within an hour - Give fluid challenge + monitor BP
How is lactate a sign of sepsis?
it is a sign of hypoperfusion (the cells are not getting sufficient O2 so have to resort to anaerobic respiration
What tests can be ordered to investigate possible sepsis?
- Biochemistry (Blood test)
- Blood culture
What can the blood test pick up?
- ⬆️ CRP (acute marker of inflammation)
- ⬆️ Creatinine (sign of AKI)
- ⬆️ Lactate
- ⬆️ WCC
What are the pre-renal causes of AKI?
dehydration
What are the renal causes of AKI?
- toxins
- glomerulosclerosis
What are the post-renal causes of AKI?
- prostrate enlargement
- kidney stones
What does the NEWS2 score used for and what does it assess?
It is used for monitoring and escalating. It measures…
- O2 sats
- Temperature
- BP
- RR
- Pulse
- ACVPU scale
Name the abdominopelvic regions.
right hypochondriac, right lumbar, right illiac, epigastric, umbilical, hypogastric (or pubic), left hypochondriac, left lumbar, and left illiac divisions
What is a diverticulum?
A small pouch that pushes out through the weak spots in the outer layer of the wall of the intestines (usually large).
Who is at risk of developing diverticula?
- old people
- people with poor diet
What primarily causes diverticula and how?
Insufficient fibre in diet
- If you don’t eat enough fibre, stools tend to be drier and more difficult to move along the gut.
- The muscles have go work harder to move the stools and the high pressure that develops can push the inner lining of the gut through to form a diverticulum.
What is diverticulosis?
It means that diverticula are present, but do not cause any symptoms or problems.
What is diverticular disease?
It is the condition where the diverticula cause intermittent, lower abdominal pain or bloating -> there is no inflammation.
What are the symptoms of diverticular disease?
- Bloating
- Lower abdominal pain (left lower quadrant)
- Bloating
- Diarrhoea/ constipation
- PR bleeding
What conditions present similarly to diverticular disease?
- IBS (though this is more common in young people)
- Early bowel cancer
How can diverticular disease be treated?
- High fibre diet
- Drink water
- Take paracetamol
What is diverticulitis?
It is the condition where the ≥ 1 diverticula get inflamed and infected.
What can cause diverticulitis?
If faeces get trapped in a diverticulum as the bacteria in the faeces can cause infection.
What are the symptoms of diverticulitis?
- Constant pain in the abdomen
- Pyrexia
- Constipation/ diarrhoea
- Blood in stool
- Nausea/ vomiting
What are the complications of diverticulitis?
- Bowel obstruction
- Abscess formation (collection of pus)
- Fistula formation (a channel may form to nearby organs)
- Perforation of the wall of the bowel -> peritonitis
How can diverticulitis be treated?
- Abx for mild symptoms
- IV (if vomiting)
- Surgery (for complications)
