Shock + Sepsis

Question 1

How is systemic inflammatory response syndrome defined?

Answer 1

Presence of at least 2 of the following:
-Temp >38 or <36
-HR >90
-RR >20
-WCC >12x10^9 or <4x10^9

Question 2

What is included in the NICE traffic light system to evaluate red flag sepsis?

Answer 2

-Systolic BP <90
-HR >130
-O2 sats <91
-RR >25
-Lactate >2.0
-Responds only to voice/pain or is unresponsive
Immediate action is required if any of the above are present

Question 3

What does the acronym HEP B denote for examining a septic patient?

Answer 3

HANDS - sweaty, cold/hot, cap refill time
END ORGAN PERFUSION - drowsy, urine output
PULSE - rate, volume
BP - hypotension

Question 4

What investigations should be carried out for a septic patient?

Answer 4

Bloods
-FBC
-U+Es (dehydration)
-LFTs (hypoalbuminaemia)
-Glucose (hyperglycaemia)
-Clotting screen, D-dimer (DIC)
-Blood cultures
Urine
-Dip, microscopy, culture and sensitivity
ABG (metabolic acidosis)

Question 5

How should you manage a septic patient?

Answer 5

BUFALO
-Blood cultures
-Urine (hourly measurement of output)
-Fluids (500ml normal saline over 15min)
-Abx (start IV broad spectrum abx eg tazocin)
-Lactate (serial measurements)
-Oxygen (15L via NRBM)

Question 6

What is shock?

Answer 6

-Clinical syndrome caused by inadequate tissue perfusion and oxygenation leading to abnormal metabolic function

Question 7

What happens as a result of shock?

Answer 7

-Intracellular calcium overload –> decreased myocardial contractility
-H+ excess –> decreased myocardial function
-Metabolism becomes glycolysis dependent –> raised lactic acid

Question 8

How do you manage a patient in shock?

Answer 8

-Oxygen 15L/min NRBM
-2x IV access, give 500ml NaCl bolus then reassess
–Caution if cardiogenic
–Consider blood transfusion if hypovolaemic
-If no improvement after 2 boluses –> ICU