Sepsis Flashcards
What is the symptom sieve for patients with an altered mental state?
Primary neurological Infection Cardiorespiratory Gastrointestinal Metabolic/endocrine toxins Psychiatric
What is an A-E assessment?
An A-E assessment is conducted when encountering an unwell patient, ensuring that life threatening issues are identified and systematically treated. Airways Breathing Circulation Disability Exposure
What are the 5 assessment criteria for airways?
1) There may be paradoxical chest and abdominal movements
2) Use of accessory muscles
3) Partial obstruction –> Noisy breathing (snoring, stridor, wheeze), with diminished air entry.
4) There are no breath sounds at the nose or mouth in total obstruction
5) Central cyanosis is a late sign
What breathing noise patterns are heard in patients with a partial obstruction?
Snoring, stridor and wheeze
What breath sounds can be heard in patients with total obstriction?
There are no breathing sounds
What is the latest sign of airways assessment?
Central cyanosis
What are the 5 actions for airways?
1) Airway manoeuvres -head tilt and chin lift or jaw thrust.
2) Suction to remove debris (Do not use fingers)
3) Simple airway adjuncts Nasopharyngeal airway, oropharyngeal (Guedel). Supraglottic airway (iGel).
4) Advanced airway interventions Intubation, emergency surgical airway
5) Give oxygen at high concentration
A decreased GCS <8 requires what?
Intubation
How should oxygen saturation be measured?
With a pulse oximeter , and count RR
A trachea deviation may indicate what pathology?
Pneumothorax or large effusion on the contralateral side or collapse on the ipsilateral side.
What percussion pattern is heard in patients with pneumothorax?
Hyperresonance
Dullness in percussion suggests what?
Consolidation of pleural fluid.
In a pneumothorax, what chest sounds are heard?
Absent or reduced sounds.
What is the emergency treatment for pneumothorax?
Chest drainage
What is the emergency treatment for anaphylaxis?
Adrenaline
What is the emergency treatment for an opioid overdose?
Naloxone
What is the %was oxygen saturation target for critically ill patients?
94%
What should be used to improve ventilation and oxygenation in patients if the depth of breathing is insufficient?
Bag-mask or pocket mask
Why should patients with COPD be on oxygen between 88-92%?
Patients with COPD have chronic hypercarbia, relies on hypoxic drive. High flow oxygen can remove their driving factor for ventilation Respiratory distress
What is considered to be the primary cause of circulatory failure?
Hypovolemia
Why is there an elevated heart rate in hypotensive patients?
Physiological response of atrial stretch and baroreceptors sending vagal sympathetic stimulation to the cardio-respiratory control centres in the medulla Increased sympathetic activity of the heart, release of NA onto the SAN.
What ECG abnormality will illustrate a patient experiencing an MI or ischaemic related change?
ST-elevation
What is the parameter for a normal capillary refill time?
Less than 2 seconds
How is the capillary refill time measured?
Apply cutaneous pressure for 5 seconds on a fingertip at heart level to cause blanching Time how long it takes for the skin to return to its previous colour after releasing. A normal CRT <2 seconds. Prolonged CRT suggests poor peripheral perfusion.
What does an elevated JVP suggest?
Heart failure or fluid overload.
A barley palpable central pulse suggests what?
Poor cardiac output.
What does a bounding peripheral and central pulse indicate?
Sepsis
What blood test parameter is used to measure tissue perfusion?
Lactate level
What are the four types of shock?
Hypovolemic
Cardiogenic
Obstructive
Distributive
What is a hypovolemic shock?
(Decrease in the volume of blood, as occurs after internal or external haemorrhaging, burns, dehydration or severe vomiting/diarrhoea).
What is a cardiogenic shock?
(Reduced activity of the heart, as in coronary thrombosis, myocardial infarction, or pulmonary embolism, this results in inadequate perfusion).
What are the three main forms of a distributive shock?
Sepsis
Anaphylactic
neurogenic
What is a septic shock?
• Septic shock is associated with a resultant systemic inflammatory response associated with DIC, and multiple organ failure. Widespread vasodilation of blood vessels, thus insufficient blood to fill them.
What causes an anaphylatic shock?
Caused by a severe allergic reaction ,histamine release induces vasodilation
What is the main causes of a neurogenic shock?
Overdosage of drugs (opioids or barbiturates), or emotional shock due to a personal tragedy.
What is one of the primary assessments conducted for disability as part of the ABCDE assessment?
Glucose
What are the 7 assessment features for disability?
1) Don’t ever forget glucose (ABC-DEFG).
2) Temperature
3) Assess the neurological status: Rapid assessment ACVPU (Alert-confused-respond to voice- respond to pain – unresponsive).
4) Glasgow coma scale.
5) Check for pupil size, equality and reactivity to light.
6) Assess for pain
7) Check the drug chart
What four parameters indicate a patients with SIRS?
More than or equal to two of: Temperature: >38 or <36 Heart rate: >90bpm RR > 20 WBC >12 <4 x10^9/L.
What is the difference between SIRS and sepsis?
Meets SIRS criteria with evidence of infection, conduct blood cultures.
What is severe sepsis?
Sepsis with evidence or organ dysfunction, hypotension or hypoperfusion
What tests should be done to diagnose a patient with severe sepsis?
Lactate and urine output
What is a septic shock?
Severe sepsis with hypotension despite adequate fluid resuscitation
There is multi-organ failure.
What is the sepsis six?
- Give oxygen to keep saturation above 94%
- Take blood cultures
- Give IV antibiotics
- Give challenge
- Measure lactate (Anaerobic respiration due to inadequate oxygen perfusion to tissues (hypoperfusion)).
- Measure urine output
What is C-reactive peptide (CRP) a marker of?
A marker of inflammation
What does neutrophillia and an elevated WBC suggest?
Indicative of infection and cytokine storm of inflammatory exaggeration
What does an elevated serum lactate suggest?
Hypoperfusion, an inadequate supply to tissues
How frequently should a patient be monitored with a new score between 1-4?
Minimum 4-6 hourly
How frequently should a patient be monitored with a 3 in a single parameter?
Minimum 1 hourly
How frequently should a patient be monitored with a NEW score of 5+
Minimum 1 hourly
How frequently should a patient be monitored with a NEW score of 7+?
Continuous monitoring of vital sounds
What is the clinical response for a patient with 1-4 score?
Inform registered nurse to assess the patient
Nurse decides whether there should be increased frequency of monitoring or escalation.
What is the clinical response for a patient with a NEW score of 5+?
Registered nurse to immediately inform the medical team caring for the patient.
- Urgent assessment by clinician or team with core competencies in the care of acutely ill patients
- Provide clinical care in an environment with monitoring facilities.
What is the clinical response for a patient with a NEW score of 7?
Inform medical team immediately, specialist registrar.
Emergency assessment with critical care competencie, with practitioners with advanced airway management skills
ICU
What are the four man causes of confusion?
Infection
GI
Toxins
Psychiatric
What abdominal structures reside within the left iliac fossa?
The descending and sigmoid colon.
What are the 9 abdominal divisions?
Right hypochondriac Left hypochondriac Epigastric right lumbar left lumbar umbilical right iliac left iliac hypogastric
