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Acute finals > Sepsis + shock > Flashcards

Sepsis + shock Flashcards

1
Q

Define sepsis

A

Life-threatening organ dysfunction that occurs due to dysregulated immune response to an infection

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2
Q

Describe the criteria for sepsis

A

Use qSOFA

  • Reduced GCS
  • Increased RR (22+)
  • Hypotension (<100)
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3
Q

Define septic shock

A

Sepsis with significant circulatory compromise, can be identified clinically as patients requiring vasopressors + lactate >2mmol/L

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4
Q

Describe the risk factors for sepsis

A
  • Older age
  • Frailty
  • Immunosuppressed, HIV, alcoholics
  • Hospitalisation: indwelling lines, recent surgery etc
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5
Q

What are the common sources of infection in sepsis?

A

Urinary tract very common (urosepsis)
Resp tract
Blood (septicaemia)
Abdo (intra-abdominal, biliary sepsis)

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6
Q

Describe the presentation of sepsis

A
  • Acute deterioration with infection
  • Fever, focal symptoms
  • Tachycardia, tachypnoea, hypoxia
  • Pale, cold peripheries, weak pulses
  • Hypotension
  • Reduced urine output
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7
Q

Describe the investigations for sepsis

A

If suspected:

  • Urine dip + MCS
  • Bloods: FBC, CRP, U+Es, LFTs, culture, VBG/ABG
  • CXR
  • Others as indicated eg. LP, CT head
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8
Q

Describe the management of sepsis

A

A to E
Admit, senior review
Sepsis 6:
-Take: lactate, blood cultures, measure urine output
-Give: high flow O2 (target sats 94-96), IV fluids + ABx
Monitor, be aware of need for vasopressors/ITU

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9
Q

Describe the complications of sepsis

A
  • AKI + complications
  • Acidosis
  • ARDS
  • Multi-organ dysfunction
  • DIC
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10
Q

What is febrile neutropenia? Who is at risk?

A

A fever >38.3 in a neutropenic patient (ANC <500). Implies infection that has a very high risk of sepsis + mortality
RFs: patients on chemotherapy (esp haem malignancy)

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11
Q

Describe the presentation of febrile neutropenia

A

Fever >38.3

May not have any localising symptoms/signs

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12
Q

Describe the investigations + management of febrile neutropenia

A 
Important to look for source of infection eg. swabs, skin examination, CXR, blood cultures, urine
Management:
-Admission
-Sepsis 6 
-BS antibiotics eg. Tazocin 
-Consider G-CSF
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13
Q

Describe multi-organ dysfunction syndrome

A

Dysfunction in 2+ organ systems that occurs in acute illness eg sepsis, burns, trauma. May include:

  • AKI
  • Liver failure eg. bleeding, encephalopathy
  • DIC
  • ARDS
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14
Q

Describe the management of multi-organ dysfunction syndrome

A
  • ITU
  • Supportive Mx: fluids, I+V, haemodialysis, etc
  • Manage underlying cause: IV ABx, etc
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15
Q

Define shock. What are the types of shock and what are some causes of each?

A

A life-threatening condition caused by inadequate tissue perfusion.
Hypovolaemic: haemorrhage, dehydration, pancreatitis
Septic: sepsis
Cardiogenic: cardiac (ischaemia, arrhythmia, cardiomyopathy), resp (tension PT, PE)
Anaphylactic

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16
Q

Describe the presentation of the different types of shoc

A

Hypovolaemic: patient is dry, cool. JVP low.
Septic: patient is warm, dry. JVP low
Cardiogenic: patient is cool, overloaded. JVP raised
Anaphylactic: signs of anaphylaxis

17
Q

Describe the management of shock briefly by type

A

Hypovolaemic: fluid resus
Septic: fluid resus + IV ABx
Cardiogenic: dobutamine
Anaphylaxis: IM adrenaline

18
Q

Describe the management of hypovolaemic shock (more detailed)

A

A to E

  • High flow O2 if low sats
  • IV access, bloods + fluid resus
  • IV fluid bolus: 500mls crystalloid over 15 mins. Repeat as needed. Senior needed if giving >2L
  • Investigate cause eg. bleeding
19
Q

Describe the management of septic shock

A

Manage as per sepsis.

Probably needs ITU + vasopressors

20
Q

Describe the management of cardiogenic shock

A

A to E

  • High flow O2 if low sats
  • ECG, IV access, bloods
  • Treat any cardiac abnormality eg. arrhythmia -> DCCV, MI -> reperfusion
  • CXR/CTPA
  • > dobutamine
21
Q

Describe the indications for:

  • Dobutamine
  • Dopamine
  • Noradrenaline/adrenaline
A

Dobutamine: used in cardiogenic shock. Increases cardiac contractility + vasodilation
Dopamine: used in cardiogenic shock. Increases cardiac contractility + vasoconstriction + improves blood flow to kidneys.
Noradrenaline: used in septic shock. Causes vasoconstriction primarily.

Acute finals (6 decks)

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