Sepsis, Shock, Anaphylaxis & Cardiac Arrest Flashcards
What are the symptoms of anaphylaxis?
- chest tightness
- wheeze
- breathlessness
- itching
- swelling
What are the EARLY signs of anaphylaxis?
- urticaria
- bronchospasm / stridor
- vomitting / diarrhoea
- flushing
- abdominal pain
- impending sense of doom
What are the LATER signs of anaphylaxis?
- hypotension
- tachycardia
- tongue / preorbital swelling
- cyanosis
- wheeze
Which drugs can commonly cause anaphylaxis?
penicillins, anaesthetic drugs, contrast, blood products
What are the worrying signs of anaphylaxis?
- No respiratory / cardiac effort
- BP <90 systolic
- Falling o2 sats
- Chest tightness
- Stridor
If worrying signs of anaphylaxis are present, what should you do?
- Dial 2222 - get the crash trolley
2. Get senior help!
What are the steps for immediate anaphylaxis management?
- Dial 2222 - get the crash trolley.
- Call for senior help.
- Check if px has any known allergy.
- Give 0.5ml 1:1000 adrenaline (epinephrine) - can repeat after 5 mins if no better.
- Stop exposure if possible e.g. IV Abx / blood transfusion.
Rx for anaphylaxis?
0.5 ml, 1:1000, IM adrenaline (500 micrograms) - repeat after 5 mins if no better.
ABCDE for anaphylaxis
A = GCS <8 or airway concerns - call anaesthetist + consider adjunct.
B = sit px up + 15L/min o2 nrb mask + pulse oximetry + full set of obs + auscultate chest + consider nebulised salbutamol/adrenaline for bronchospasm.
C = ECG + wide-bore bilateral IV access (FBC, U+E, mast cell tryptase) after adrenaline given.
D = monitor GCS
E = examine px for rash + chlorphenamine 10mg IM or slow IV (adults) + hydrocortisone 200mg IM or slow IV.
REPEAT MAST CELL TRYPTASE - 1hr/ 6-24hr post reaction.
Define SIRS?
“Systemic Inflammatory Response Syndrome”
- HR >90
- RR >20 or PaCO2 <4.3
- WCC >12 or <4
- Temp >38.3 or <36
- Altered mental status
- Glucose >7.7 in non-diabetics.
NEED 2+ TO BE SEPSIS.
Define:
- Sepsis
- Severe sepsis
- Septic shock
- SIRS criteria + identified/ suspected source of infection.
- Above + evidence of end organ dysfunction. 35% mortality.
- Hypotension despite adequate fluid resusitation (BP <90/60, MAP <65, lactate >4).
How does severe sepsis affect:
- Lungs
- Kidneys
- Liver
- Other
Lungs:
- Sp02 <90% or <94% despite O2 therapy
- Acute lung injury (PaO2/FiO2 ratio)
Kidneys:
- Urine output = <0.5ml/kg/hr for 2+ hrs
- Creatinine >176.8
Liver:
- INR >1.5 or PTT >60 (without anticoagulation therapy)
- Billirubin >34.2
Other:
- Platelets <100
- Lactate >2
- Ileus / absent BS
- CRT >3 seconds
Explain ‘BUFALO’
B = Blood cultures - peripheral blood, urine, lines, wound swabs, sputum, stool, CSF.
U = Urine output - catheterise + start fluid balance chart.
F = Fluids - 500ml crystalloid bolus (250ml if elderly / congestive cardiac failure).
A = Abx - consult guidelines, start within 1 hr of diagnosis sepsis.
L = Lactate = measure via ABG/ VBG.
O = O2 to maintain sats as appropriate (88-92% - COPD + 95-98% - normal).
What are the aims of sepsis Rx?
- BP >100 systolic or MAP >65
- Urine output >0.5ml/kg/hr
- Lactate <2 after fluid resuscitation
- Maintain BG <8.3
What can critical care offer?
- 1:1 / 1:2 nursing.
- Invasive BP monitoring (via arterial/ central lines) + control.
- Vasopressor therapy (e.g. noradrenaline).
- Renal support - haemofiltration.
- Sedation + intubation (reduce metabolic demands, give respiratory support - optimisation).