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CSI > Sepsis > Flashcards

Sepsis Flashcards

1
Q

What is the symptom sieve for patients with an altered mental state?

A 
Primary  neurological 
Infection 
Cardiorespiratory 
Gastrointestinal 
Metabolic/endocrine
toxins
Psychiatric
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2
Q

What is an A-E assessment?

A 
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
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3
Q

What are the 5 assessment criteria for airways?

A

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

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4
Q

What breathing noise patterns are heard in patients with a partial obstruction?

A

Snoring, stridor and wheeze

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5
Q

What breath sounds can be heard in patients with total obstriction?

A

There are no breathing sounds

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6
Q

What is the latest sign of airways assessment?

A

Central cyanosis

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7
Q

What are the 5 actions for airways?

A

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

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8
Q

A decreased GCS <8 requires what?

A

Intubation

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9
Q

How should oxygen saturation be measured?

A

With a pulse oximeter , and count RR

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10
Q

A trachea deviation may indicate what pathology?

A

Pneumothorax or large effusion on the contralateral side or collapse on the ipsilateral side.

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11
Q

What percussion pattern is heard in patients with pneumothorax?

A

Hyperresonance

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12
Q

Dullness in percussion suggests what?

A

Consolidation of pleural fluid.

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13
Q

In a pneumothorax, what chest sounds are heard?

A

Absent or reduced sounds.

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14
Q

What is the emergency treatment for pneumothorax?

A

Chest drainage

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15
Q

What is the emergency treatment for anaphylaxis?

A

Adrenaline

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16
Q

What is the emergency treatment for an opioid overdose?

A

Naloxone

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17
Q

What is the %was oxygen saturation target for critically ill patients?

A

94%

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18
Q

What should be used to improve ventilation and oxygenation in patients if the depth of breathing is insufficient?

A

Bag-mask or pocket mask

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19
Q

Why should patients with COPD be on oxygen between 88-92%?

A

Patients with COPD have chronic hypercarbia, relies on hypoxic drive. High flow oxygen can remove their driving factor for ventilation  Respiratory distress

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20
Q

What is considered to be the primary cause of circulatory failure?

A

Hypovolemia

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21
Q

Why is there an elevated heart rate in hypotensive patients?

A

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.

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22
Q

What ECG abnormality will illustrate a patient experiencing an MI or ischaemic related change?

A

ST-elevation

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23
Q

What is the parameter for a normal capillary refill time?

A

Less than 2 seconds

24
Q

How is the capillary refill time measured?

A

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.

25
Q

What does an elevated JVP suggest?

A

Heart failure or fluid overload.

26
Q

A barley palpable central pulse suggests what?

A

Poor cardiac output.

27
Q

What does a bounding peripheral and central pulse indicate?

A

Sepsis

28
Q

What blood test parameter is used to measure tissue perfusion?

A

Lactate level

29
Q

What are the four types of shock?

A

Hypovolemic
Cardiogenic
Obstructive
Distributive

30
Q

What is a hypovolemic shock?

A

(Decrease in the volume of blood, as occurs after internal or external haemorrhaging, burns, dehydration or severe vomiting/diarrhoea).

31
Q

What is a cardiogenic shock?

A

(Reduced activity of the heart, as in coronary thrombosis, myocardial infarction, or pulmonary embolism, this results in inadequate perfusion).

32
Q

What are the three main forms of a distributive shock?

A

Sepsis
Anaphylactic
neurogenic

33
Q

What is a septic shock?

A

• 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.

34
Q

What causes an anaphylatic shock?

A

Caused by a severe allergic reaction ,histamine release induces vasodilation

35
Q

What is the main causes of a neurogenic shock?

A

Overdosage of drugs (opioids or barbiturates), or emotional shock due to a personal tragedy.

36
Q

What is one of the primary assessments conducted for disability as part of the ABCDE assessment?

A

Glucose

37
Q

What are the 7 assessment features for disability?

A

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

38
Q

What four parameters indicate a patients with SIRS?

A 
More than or equal to two of:
Temperature: >38 or <36
Heart rate: >90bpm
RR > 20
WBC >12 <4 x10^9/L.
39
Q

What is the difference between SIRS and sepsis?

A

Meets SIRS criteria with evidence of infection, conduct blood cultures.

40
Q

What is severe sepsis?

A

Sepsis with evidence or organ dysfunction, hypotension or hypoperfusion

41
Q

What tests should be done to diagnose a patient with severe sepsis?

A

Lactate and urine output

42
Q

What is a septic shock?

A

Severe sepsis with hypotension despite adequate fluid resuscitation

There is multi-organ failure.

43
Q

What is the sepsis six?

A
  1. Give oxygen to keep saturation above 94%
  2. Take blood cultures
  3. Give IV antibiotics
  4. Give challenge
  5. Measure lactate (Anaerobic respiration due to inadequate oxygen perfusion to tissues (hypoperfusion)).
  6. Measure urine output
44
Q

What is C-reactive peptide (CRP) a marker of?

A

A marker of inflammation

45
Q

What does neutrophillia and an elevated WBC suggest?

A

Indicative of infection and cytokine storm of inflammatory exaggeration

46
Q

What does an elevated serum lactate suggest?

A

Hypoperfusion, an inadequate supply to tissues

47
Q

How frequently should a patient be monitored with a new score between 1-4?

A

Minimum 4-6 hourly

48
Q

How frequently should a patient be monitored with a 3 in a single parameter?

A

Minimum 1 hourly

49
Q

How frequently should a patient be monitored with a NEW score of 5+

A

Minimum 1 hourly

50
Q

How frequently should a patient be monitored with a NEW score of 7+?

A

Continuous monitoring of vital sounds

51
Q

What is the clinical response for a patient with 1-4 score?

A

Inform registered nurse to assess the patient

Nurse decides whether there should be increased frequency of monitoring or escalation.

52
Q

What is the clinical response for a patient with a NEW score of 5+?

A

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.
53
Q

What is the clinical response for a patient with a NEW score of 7?

A

Inform medical team immediately, specialist registrar.
Emergency assessment with critical care competencie, with practitioners with advanced airway management skills
ICU

54
Q

What are the four man causes of confusion?

A

Infection
GI
Toxins
Psychiatric

55
Q

What abdominal structures reside within the left iliac fossa?

A

The descending and sigmoid colon.

56
Q

What are the 9 abdominal divisions?

A 
Right hypochondriac
Left hypochondriac
Epigastric
right lumbar 
left lumbar
umbilical 
right iliac
left iliac
hypogastric

CSI (2 decks)

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