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RENAL BS > Sepsis and fluid > Flashcards

Sepsis and fluid Flashcards

1
Q

what indicates an adult have a suspected infection?

A
  1. respiratory rate is high
  2. altered mentation
  3. systolic bp <100MM Hg
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2
Q

what is septic shock?

A

a subset of sepsis

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3
Q

what does septic shock cause?

A

profound circulatory, cellular and metabolic abnormaltities

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4
Q

what is lactate a marker of?

A

anaerobic respiration/ischaemia (not enough blood supply to organs)

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5
Q

what does sepsis cause?

A
  1. Endothelial dysfunction
  2. Coagulopathy
  3. Cellular dysfunction
  4. Cardiovascular dysfunction
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6
Q

What happens in multiple organ failure?

A
  1. acute lung injury
  2. Cardiovascular instability (hypotension)
  3. Acute kidney injury
  4. gastrointestinal mucosal injury
  5. Liver dysfunction
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7
Q

who is more vulnerable to sepsis?

A
  1. Children <1
  2. Adults >75
  3. Frail people
  4. Patients with recent trauma or surgery/invasive procedure (within 6 weeks)
  5. Impaired immunity due to illness and drugs
  6. Patients with indwelling lines/catheters
  7. Iv drug misusers
  8. Patients with breach of skin integrity
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8
Q

how to recognise sepsis?

A
  1. Consider signs + symptoms
  2. Be aware that people with sepsis may have non-specific , non localising presentations
    e. g just feeling unwell
  3. Pay attention to concerns expressed by the person and family/carer
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9
Q

What puts a patient in high risk criteria?

A

1.Evidence of new altered mental state
2.Respiratory rate: >25 breaths per minute
3.Need for new O2
e.g 40% FiO2 to maintain O2 saturation higher than 92%
88% O2 sat in known chronic obstructuve pulmonary disease.
4.High heart rate > 130 bpm

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10
Q

What puts a patient in high risk criteria? (cont).

A
  1. systolic BP < 90 mmHg
  2. systolic BO >40 mmHg
  3. Not passed urine in previous 18 hours
  4. Mottled or ashen appearance
  5. cyanosis
  6. non-blanching rash of skin (could be meningitis)
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11
Q

How to initially respond to sepsis?

A

Carry out venous blood test for :

  1. blood gas
  2. blood culture
  3. full blood count
  4. C-reactive protein
  5. Urea and electrolytes creatine
  6. clotting screen
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12
Q

2nd test to respond to suspected sepsis?

A

Culture (sputum, urine, wound swab)

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13
Q

What acronym to follow?

A

Blood cultures and septic screen

Urine output-monitor hourly

Fluid resuscitation

Antibiotics IV-LTHT guidelines

Lactate measurement-from an arterial or venous blood gas

Oxygen-to correct hypoxia

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14
Q

What acronym to follow?

A

Blood cultures and septic screen

Urine output-monitor hourly

Fluid resuscitation

Antibiotics IV-LTHT guidelines

Lactate measurement-from an arterial or venous blood gas (>2)

Oxygen-to correct hypoxia (titrate O2)

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15
Q

women composition of water?

A

45-50%

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16
Q

men composition of water?

A

50-60%

17
Q

what maintains oncotic pressure?

A

Albumin

18
Q

What happens to albumin in sepsis?

A

It leaks out into interstitial space as epithelium of capillary is attacked

19
Q

Normal intracellular Na+ and K+ level?

A

Na + = 10 mmo/L

K+ = 160 mmo/L

20
Q

What type of IV fluids do you use?

A
  1. Crystalloids
  2. Balanced crystalloids(more physiological)
  3. Blood products
21
Q

What is crystalloid?

A

water to which solutes have been aded
High NA+ containing fluids
Low sodium fluids

22
Q

What are examples of blood products?

A

Packed red cells

Albumin

23
Q

What does Hartmans solution contain?

A 
Na+ = 131 mmol/L
Cl-= 111 mmol/L
Lactate= 29 mmol/L
Ca2+= 2 mmol/L
24
Q

What does Sodium chloride solution contain?

A 
Na+ = 154 mmol/L
Cl- = 154 mmol/L
25
Q

Possible side effects of Hartmans solution ?

A

Hyperkalamia

26
Q

Possible side effects of Sodium chloride solution?

A

Hyperchloraemic metabolic acidosis

27
Q

why do we want to get patients out of hospital as quick as possible?

A
  1. hospital acquired pneumonia
  2. DVT
  3. Hospital acquired infection (C diff)
28
Q

How to correct hypovalaemia?

A

restoring the circulating volume by :

  1. rapidly expanding the intravascular space
  2. restoring blood pressure and organ perfusion

RENAL BS (2 decks)

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