Shock 2 - Dx + Mx

Question 1

MEWS
>? = urgent med review
>? = critical care teams involved

Answer 1

3

5

Question 2

Systemic Inflammatory Response Syndrome (SIRS);

?+ from new;
Temp: >38.?° or <3?°
RR: >? (or pCO2 ?
WCC:  or >? 
(or acutely altered ? ?, or glucose >? in a non-diabetic).

Answer 2

2
.3
36
20
4.3
90
4, 12
mental state
7.7

Question 3

Sepsis= SIRS + a suspected site of ?.

Severe Sepsis= Sepsis + ? OR evidence of end organ dysfunction (oliguria, confusion, lactate >?, SpO2 <9?%).

Septic shock - severe sepsis with hypotension ? ? to fluid resus.

Answer 3

infection
hypotension
2
4
not responding

Question 4

Septic shock mx

? ? within ? hours

?;
o IN: Start with l5L/min via a non-rebreather mask, aiming to achieve
>94% saturations. Can later titrate down to 88-92% in ? patients
IV ?; ·
o IN: ? crystalloid stat if hypotensive or lactate >?, and review response to this bolus.
IV ?;
o IN: according to local guidelines, ask nurses to give this ?.

Answer 4

sepsis six
1
o2
copd
fluids
500ml
2
abx
immediately

Question 5

Septic shock mx

Serum ?/ Hb;
o OUT: blood gas can be venous or arterial, seek urgent senior review if
lactate >? regardless of blood pressure.
?;
o OUT: ideally prior to Abx administration (but do not delay), take ? ? from separate sites, plus from all ? ? and the
suspected source, e.g. ? in pneumonia
?;
o OUT: Most reliable measure of ?-? ?, plus keep a strict fluid ?.

Answer 5

lactate
4
cultures
two pairs
indwelling lines
sputum
catheterise
end-organ perfusion
balance

Question 6

Anaphylactic Shock . .
- Type I lg? mediated hypersensitivity reaction, occurring in response to an
antigen that the body has previously been sensitised to.
Degranulation of mast cells leads to release of vasoactive mediators such as
? that cause excessive ? of the venous system
This is compounded by ? and laryngeal ?

Answer 6

e
histamine
vasodilation
bronchoconstriction
oedema

Question 7

Acute Management (ABCDE); Anaphylaxis

Secure the airway (? if obstruction imminent).
? the cause.
? ?mg ? {0.5ml of 1:1000), repeat every ? minutes if necessary.
? ?mg IV.
? ?mg IV.
If ?, treat as per acute asthma also.
? the ? of the bed to help restore circulation.
Interval bloods for serum ? and ? to confirm diagnosis

Answer 7

intubate
remove
adrenaline 0.5mg IM
5
chlorphenamine 10
Hydrocortisone 300
wheeze
raise
feet
tryptase, histamine

Question 8

Anaphylaxis

Further Management
May need ? admission.
Will need ? monitoring wherever admitted.
Longer term will need ? and ?-? testing.

Answer 8

itu
ecg
epi-pen, skin-prick