Sepsis and shock

Question 1

Shock-

Answer 1

-imbalance between oxygen supply and demand

Question 2

Types of shock

Answer 2

-cardiogenic- heart can’t pump enough blood to meet demand
-hypovolemic- caused by cat haem, internal bleeding, vomiting/ diarrhoea
-septic
-neurogenic- eg. spinal shock causing vasodilation and decreasing BP
-anaphylactic

Question 3

Types distributive shock

Answer 3

-neurogenic
-anaphylaxis
-septic

Question 4

BP and cardiac output equations

Answer 4

BP= cardiac output x peripheral resistance
Cardiac output= stroke vol x heart rate
therefore…
BP= stroke vol x heart rate x peripheral resistance

Question 5

Clinical features of shock (due to body trying to compensate) and cause

Answer 5

Hypotension- reduced cardiac output and circulating blood volume
Tachycardia/ weak pulse- HR increases to increase output
Increase resp- due to lactic acid produced due to anaerobic respiration
Pallor- peripheral vasoconstriction so blood diverted to vital organs
Cyanosis- poor oxygenation of blood
Oliguria- decreased urine output, more fluid reabsorbed to increase BP
Altered consciousness- lack oxygen to brain

Question 6

Septicaemia-
Sepsis-

Answer 6

-presence of large numbers of disease producing organisms in the circulating blood
-bodies response to large numbers of disease producing organisms in the circulating blood (syndrome not specific illness)

Question 7

Steps of septic shock

Answer 7

-wbcs detect pathogen in blood and recruit more wbcs and release molecules to cause vasodilation
-this happens systematically, causing reduced BP
-permeability increases causing fluid to get into tissues
-more difficult for O2 to reach tissue cells
-wbcs release chemicals to destroy pathogens, however this damages blood vessel walls
-walls patched via triggering of clotting cascade
-clots break off forming emboli

Question 8

Higher risk patients of sepsis

Answer 8

-very young or elderly
-pregnancy
-diabetes
-immunocompromised
-recent medical procedures
-misuse of drugs intravenously
-skin wounds
-HIV/AIDS

Question 9

Most likely causes of sepsis

Answer 9

-pneumonia- 50%
-appendicitis
-UTI
-cellulitis or infected wound
-neutropenic sepsis- patients who have had cancer therapy, reduced immune response causing infection to escalate to sepsis quickly

Question 10

Steps of assessment

Answer 10

1. anyone presenting with shock think could this be sepsis? think about high risk groups
2. NEWS2 score- score of 5 or more predicts at least a twofold increase in risk of adverse outcomes
3. risk stratification- use traffic light system and apply to patient, only need one criteria to be in that category (JRCALC)

Question 11

When to suspect sepsis

Answer 11

-anyone presenting with fever/ feeling unwell
AND/OR
-NEWS2 greater than or equal to 5
-looks unwell with history of infection

Question 12

Management plan red flag sepsis

Answer 12

-CABCD approach, correct any first
-oxygen- maintain 94-98%
-IV fluids
-DO NOT DELAY ON SCENE- pre alert with ATMIST saying red flag sepsis

Question 13

Fluid therapy for sepsis

Answer 13

-give IV fluids 500ml over 15 mins
-repeat up to 4 times as required

Question 14

What makes the difference when diagnosing sepsis

Answer 14

-high index of suspicion
-early recognition
-rapid transport