SIM session_useful info Flashcards
What colour cannula should a patient who is in shock?
at least Grey 16G or Brown 14G (brown is bigger)
*not always practically easy if circulation is shout down so try with whatever you can
How we should treat a shocked patient’s hypotension?
1 litre of Hartmann’s solution
*pH neutral, crystalloid
*if saline is the only available fluid is fine to use it for short time/ resusitation
What’s the problem with bag of normal saline?
Saline is pretty acidic pH 5 -> be careful
What are the common vasopressors?
Where are they usually used?
- adrenaline
- noradrenaline
- vasopressin analogue
*used usually in ITU; Rx for very septic patients when danger of fluid overload (and oedema)
Where is the lactate coming from?
Hypoxic tissues -> anaerobic respiration -> lactate is created
- Anaerobic respiration is happening due to organ underperfusion/oxygen is not delivered to the tissues by blood
- circulatory collapse = hypotension & small blood clots in the areas of tissue = ischaemia
What’s the normal lactate range
0.5-1 mmol/L
How high is lactate in lactic acidosis?
Lactic acidosis = lactate >4 mmol/L
Potential antibiotics used for abdominal sepsis
- metronidazole
- co-amoxiclav
- cefuroxime
- Tazocin = Piperacillin/Tazobactam -> cannot be used in penicillin allergy
*depends on local resistance pattern - local hospital policy
When to check lactate?
If a patient:
- triggers NEWS of 5 or more (or 3 in a single category)
- if there is a clinical concern - if they look sick
Red flags for sepsis (5)
- significant hypotension
- significant tachycardia (HR of 130 or more)
- RR >25
- acute confusion
- decreased urine output
What questions do we ask if NEWS 5 or more?
- do they look sick?
- is it due to infection?
- are they immunocompromised
Then screen for leg flags -> if present start SEPSIS 6
