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Medicine: PBL wrap-ups > Unit 3 Case 1: Sepsis > Flashcards

Unit 3 Case 1: Sepsis Flashcards

1
Q

systemic inflammatory response syndrome SIRS

A

systemic inflammation
symptoms are fast heart rate (tachycardia), low blood pressure, very low or very high body temperature, very low or very high white cell count

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2
Q

sepsis

A

type of SIRS caused by infection
subsequent systemic inflammatory response
can result in hypoperfusion and dysfunction of major organ groups

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3
Q

septicaemia

A

name sometimes used for sepsis

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4
Q

bacteremia

A

presence of bacteria in the bloodstream

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5
Q

the innate immune system is a large part of this case

A

learn immune response

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6
Q

inflammatory response

A

started by innate immune cells, pro inflammatory cytokines and complement
localise and contain the infection
1.vasodilation and increased blood flow
2.increased vascular permeability
3.release of inflammatory mediators
4.neutrphil chemotaxis
5microvascular coagulation
6.systemic features
7.upregulation of costimulatory molecules

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7
Q

5 cardinal signs of inflammation

A

dolor
calor
rubor
tumor
functio laesa

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8
Q

what is cellulitis

A

bacterial infection of the skin
acute spreading pyogenic inflammation of the dermis and subcutaneous tissue
most commonly from staphylococci and streptococci

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9
Q

4 stages of wound healing

A

hemostasis
inflammation
proliferation
remodelling

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10
Q

hemostasis stage

A

stopping of bleeding by narrowing blood vessels
blood begins clotting by platelets forming a plug held together by fibrin
inflammation begins so the body can heal so blood flow is increased again

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11
Q

inflammation stage

A

overlaps slightly with homeostasis
neutrophils will aid in immune response followed by macrophages

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12
Q

proliferative stage

A

macrophages arrive
collagen is produced, angiogenesis

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13
Q

remodelling stage

A

involves collagen
continuously broken down and produced
to balacne the need for tensile strength and remodelling of new tissue

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14
Q

symptoms of sepsis in younger children

A

blue pale or blotchy skin, lips or tongue
rash that doesn’t fade when you press on it
difficulty breathing, breathlessness or rapid breathing
weak high-pitched cry not like normal cry
fatigue

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15
Q

symptoms of sepsis in adult or older child

A

acting confused
slurred speech
blue pale or blotchy skin lips or tongue
rash that doesn’t fade when pressed
breathlessness or fast breathing or difficulty breathing

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16
Q

what will doctors look for in sepsis assessment

A

fever
low blood pressure
high heart rate
blood tests
electrolyte imbalances
urine, wound and respiratory secretions
x ray or ultrasound

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17
Q

what could a blood test be used to identify in sepsis

A

evidence of infection
clotting problems
abnormal liver or kidney function
impaired oxygen availability

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18
Q

what is sepsis 6

A

3 diagnostic and 3 therapeutic steps to be delivered within one hour of initial diagnosis of sepsis
ensure a senior clinician attends

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19
Q

what does the sepsis 6 include

A

give high-flow oxygen
give IV antibiotics
give a fluid challenge
take blood cultures
measure lactate
measure urine output

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20
Q

gram negative bacteria

A

more difficult for uptake of nutrients as it has 2 membrane layers
cytoplasmic membrane and outer membrane
one peptidoglycan layer

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21
Q

gram positive bacteria

A

thick peptidoglycan layer
cytoplasmic membrane
more rigid
stronger cell wall

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22
Q

gram negative bacteria stains

A

stains red
thin layer of peptidoglycan and the dye will leak out and stain cell red
diderms

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23
Q

gram positive bacteria stains

A

stains purple
thick peptidoglycan layer
retains dye
monoderms

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24
Q

normal blood pressure

A

120/80 mmHg

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25
Q

normal heart rate

A

60 to 100 bpm

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26
Q

normal respiratory rate

A

12 to 16

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27
Q

normal o2 saturation

A

96% equal or higher

28
Q

normal body temperature

A

36.1-38

29
Q

GCS

A

assess wakefulness and awareness to determine consciousness
lower value the less conscious
AVPU scale
scored up to 15

30
Q

itu monitoring

A

pain
urine output
consciousness
temp
pulse
resp rate
spo2

31
Q

role of the paramedics in the emergency department

A

ambulance pre alert the ED if transporting patient needing to be received by a clinical team
patients are received by an appropriate medical team upon arrival
paramedics manage treatment until this point

32
Q

triage

A

patients who are unheralded then seen by a triage nurse on arrival
assess severity of the condition

33
Q

NHS major incident triage tool

A

catastrophic bleeding
walking
breathing
responds to voice
aged over 2
breathing rate 12-23
heart rate 100 or more

answers lead to ranking of severity

34
Q

MDT involved in emergency departments

A

consultants
registrars
hospital medical officers
nurse practitioners
physiotherapists
emergency department pharmacists
mental health emergency team
admin staff

35
Q

drugs involved in this case

A

flucloxacillin
co-amoxiclav

36
Q

flucloxacillin

A

narrow spectrum
type of penicillin beta lactase antibiotic
gram positive bacteria in skin and soft tissue infections
contains beta lactam ring
brand name: floxapen, fluclox

37
Q

co-amoxiclav

A

broad spectrum
type of penicillin beta lactase antibiotic
mix of clavulanic acid and amoxicillin
should be reserved for infections likely caused by beta lactase producing strains egg, influenzae, s aureus
gram positive and negative
brand name: augmentin, clavulin

38
Q

flucloxacillin mechanism of action

A

binds to transpeptidase, penicillin binding protein
inside bacterial cell wall
inhibits 3rd and last stage of bacterial cell wall synthesis
prevents PBPs from cross-linking D-ala-D-ala chain on a tetra peptide
cross linking of peptidoglycan walls fail to happen, walls are weak, cell lyses occurs by autolytic enzymes called autolysis
hydrolyse mucopeptide polymers in bacterial cell wall
if they attempt to divide, cell walls will collapse and kill them in the process

39
Q

co-amoxiclav mechanism of action

A

amoxicillin binds to transpeptidase
prevents PBPs from cross-linking with D-ala-D-ala chain
cell lyses occurs
clavulanic acid prevents beta lactamases from breaking down amoxicillin by binding to it

40
Q

side effects for penicillins

A

D&V
nausea
skin reaction
hypersensitivity
thrombocytopenia

41
Q

side effects of flucloxacillin

A

gastrointestinal disorders
allergy presenting as a skin rash
anaphylactic reactions, hypotension, bronchospasm, orofacial,pharyngeal and laryngeal oedema, liver toxicity

42
Q

side effects of co-amoxiclav

A

increased risk of infection
dizziness, dyspepsia, headache
colitis haemorrhagic, crystalluria, hypersensitivity vasculitis, meningitis aseptic

43
Q

sampling and testing pus by gram staining

A

5ml pus using sterile syringe
smear onto microscope slide and spread with a sterile loop
fix using methanol
apply crystal violet and iodine
then acetone or ethanol
apply stafranin
view under microscope

44
Q

results of gram staining with pus

A

positive= purple
negative= pink
cocci= round
bacilli=rod

45
Q

catalase testing

A

differentiates between staphylococci and streptococci
is an enzyme produced by microorganisms that mediates breakdown of hydrogen peroxide into oxygen and water to prevent oxidative damage to microorganisms
if effervescence then enzyme is present

46
Q

catalase testing results

A

staphylococcus is catalase positive
streptococcus is catalase negative

47
Q

coagulase test

A

staphylococcus aureus produces coagulase enzymes
converts fibrinogen in blood plasma to insoluble fibrin
coats bacteria
protects them from phagocytosis

48
Q

coagulase test results

A

staphylococcus aureus tests coagulase positive
any other staphylococci will test coagulase negative

49
Q

mannitol testing

A

based on the presence of sodium chloride
inhibits most gram negative and positive
differentiation based on ability or not to ferment the mannitol
if fermentation induces acidification which leads at pH levels below 6.9 to yellow colouration of medium in presence of phenol red

50
Q

mannitol testing results

A

if mannitol positive (ferments the sugar)
likely to be S.aureus

51
Q

antimicrobial sensitivity testing

A

uses agar plates
with antimicrobial discs
measure the zones of inhibition
to calculate efficacy of drugs or resistance of bacteria

52
Q

treatment options for sepsis

A

beta lactam/beta lactase inhibitor combinations
prevents active beta lactam from being hydrolysed so can still inhibit transpeptidases

53
Q

public health involvement for sepsis

A

CDC get ahead of sepsis
uk sepsis trust
sepsis 6
NEWs

54
Q

factors that may link to sepsis mortality

A

low income
high poverty
lack of health insurance
lower education status
access to healthcare

55
Q

factors contributing towards mental health

A

social isolation or loneliness
social disadvantage, poverty or debt
severe or long-term stress
having a long-term physical health condition
unemployment or losing job
childhood abuse, trauma or neglect
substance misuse
homelessness or poor housing
long term caring for someone

56
Q

factors affecting mental health in this case

A

relationship strains
redundancy form job
long-term stresses
lack of work-life balance
zero hour contract

57
Q

blood test results for iron deficiency anaemia

A

Hb: normal at first but will fall as anaemia worsens
RBC size/ MCV: may be decreased
RBC amount/ MCHC: may be decreased
RBC variation in size: increased

58
Q

further tests a doctor may do to confirm iron deficiency anaemia

A

serum iron
total iron binding capacity
transferrin saturation index
ferritin

59
Q

blood test results for pernicious anaemia

A

low Hb level
MCV often high

60
Q

blood film results for pernicious anaemia

A

abnormally large RBCs
abnormal shaped RBCs
occasional giant white blood cells

61
Q

other tests for pernicious anaemia

A

vitamind B12
folic acid level
methylmalonic acid
homocysteine
reticulocyte count
antibodies to intrinsic factor or parietal cell antibodies
sometimes a bone marrow aspiration

62
Q

blood test results for aplastic anaemia

A

haemoglobin may be low
RBC and WBC counts are low
platelet count is low
MCV may be normal or slightly raised
differential white blood cell count shows decrease in most types of cells but not lymphocytes

63
Q

additional testing for aplastic anaemia

A

reticulocyte count
erythropoietin
bone marrow aspiration
tests for infections such as hepatitis,EBV, CMV
test for arsenic
iron tests for vitamin B12
antibody tests for ANA

64
Q

pure red cell aplasia

A

only red blood cell precursors are absent

65
Q

testing for haemolytic anaemia

A

test for haemoglobin variants such as haemoglobin electrophoresis
DNA analysis
G6PD test
osmotic fragility test

Medicine: PBL wrap-ups (21 decks)

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