Unit 3: Sepsis

Question 1

How does NEWS score work?

Answer 1

Calculated from vital signs: RR, pulse, BP, oxygen saturation, temperature and consciousnesses (A,C, V, P,U)
A higher score indicates the patient is at a higher risk
Score of three in any category indicates an emergency
Combined scores
3- low risk
5- medium risk - immediate ward response
7- high risk - immediate specialist response

Question 2

How does the glasgow coma score work?

Answer 2

Score of patients mental consciouness and state of mind
Considers their ability to answer questions, keep eyes open and follow instructions.
Lower score may indicate lack of capacity to gice consent
Scored out of 15.
Below 13 is concerning
Below 9 - coma

Question 3

What are the features of staphylococcus aureus when testing for organisms?

Answer 3

Gram stain = positive (purple) clumps of cocci
Catalase positive
Coagulase positive
Mannitol positive - yellow agar gel rather than original red.

Question 4

How are beta lactams adminstered in a sepsis case?

Answer 4

IV

Question 5

How do you clean a wound?

Answer 5

Wash hands
Wear gloves all else should be bare below the elbow
Elevate wound and apply a gentle pressure to stop bleeding.
Wash around the wound with a light soap
Wash the wound with warm water and no soap
Ensure all debris is removed from the wound by sterilised tweezers
May add an antiseptic such as iodine
Dress in a bandage to prevent infection
Wash hands again and bin cloves in biological waste (yellow)

Question 6

What are the different types of cannulation?

Answer 6

IV - most common
1)peripheral - short term use often in surgery for fluid adminstation
2) central line - long term use, easier infection, into subclavian, jugular or femoral, for drug and fluid administration
3) Draining canulas - to remove fluid
Nasal canula - just insdie the individuals nostrils
IA - higher risk of blood loss, used to faster adminstration around the body and more accurate measure of blood pressure and contents

Question 7

What is cellulitis?
What are the signs and sympomts of cellulitis?

Answer 7

A skin infection - dermis and hypodermis layer
Wound with inflammation
Often wound turn yellow and may release pus
Painful wound
Fever, headache,

Question 8

What are the signs and symptoms of sepsis?

Answer 8

Sepsis is a SIR from an infection, often result in septic shock
Higher RR
Higher HR
Decreased oxygen saturation
Decreased BP
Declining mental status
Higher temperature (originallly) may eventually become cold to the touch despite sweating

Late stage: liver and kidney failure

Question 9

What are the risk factors for cellulitis?

Answer 9

Occupation : more likley to suffer from a skin wound e.g manual labour
Poor circulation: low BP, obesity etc
Immunocompromised- HIV
Recent walking in countryside with long grass - tick bite
Work with animals - animal bite
Hygiene - incorrect cleaning of a wound
Obesity - skin folds and sweat decreases wound healing, typically higher temperature promotes bacterial growth.

Question 10

What are the risk factors for sepsis?

Answer 10

Infection - immunocompromised
Very young, elderly and pregnant
Over use of antibiotics - remove gut flora, resistant microbe
Invasive device such as a catheter
Chronic diseases such as liver or kidney disease

Question 11

What is the role of a walk in centre?

Answer 11

Patients with uregent but non-life threatening conditions
Patientes can enter on the day, will be traiged and saw by an appropriate member of staff or referred to a more appropriate service
Often staffed by nurses and GPs

Question 12

What is the biological mechanism behind dizziness?

Answer 12

Decreased BP
Decreases arterial blood flow to the brain
Decreased oxygen supply to the brain
Temporary ischemic damage leads to the loss of postural tone

Question 13

What is the biological mechanism behind swaeting and shivering in sepsis?

Answer 13

Shivering - method of increasing body temperature, hypothalamus increases homeostasis goal to increase temp to help fight infection. Aims to denture pathogen enzymes. Change in goal temperature brought about by cytokines

Sweating - sign that the fever has broken, trying to cool down.

Question 14

What is the biological mechanism behind changes in heart rate in sepsis?

Answer 14

Low BP - detected by baroreceptors
Increased sympathetic tone
Adrenaline on B1 receptors - increase frequency of action potentials initiated by the SAN

Question 15

What are the longer term complication of sepsis?

Answer 15

Liver failure
Kidney failure
Death from organ failure

Question 16

What are some common pathogens associated with skin infections?

Answer 16

Staphyloccocus aureus
Streptococcus pyrogenes
Coryneform bacteria (gram positive rod)

Question 17

What are some commensal pathogens found on skin?

Answer 17

Staphylococcus
Micrococcus
Dermabacter
Malasezzia
Proportion changes based on the conditions of the skin (warm, moist, dry etc)

Question 18

What is the health belief model?

Answer 18

A model that predicts patient behaviour
Percieved vulnerability - by percieved susceptibility and percieved severity
Above two contribute to percieved threat
Percieved benefit from changing behaviour
Percieved barriers to changing behaviour
Self efficacy
Cues to action

Question 19

What is the sick role?

Answer 19

Parsons sick role - socially acceptable behaviour of a sick person and what support they should be given from society
Relieved of personal responsibilities, given support to help care for them in return for must be trying to get better
Is a temporary status.

Question 20

What is the QSOFA score for diagnosing sepsis?

Answer 20

Patient must be diagnosed with an infection
Patient must then have atleast2/3
- increased respiratory rate (above 22bpm)
- increased temperature (above 37 degrees)
- decreased consciousness (GCS below 13)

Question 21

What is the sepsis 6?

Answer 21

To remember how to diagnose and treat sepsis patients
1. Monitor urine levels - sign of dehydration and can indentify kidney failure
2. Take a blood sample - culture to find microbe
3. Take lactate levels (higher in oxygen deprived state)
4. Give IV antibiotics
5. GIve high flow oxygen
6. Give IV fluids - to increase BP and maintain cardiac output

Question 22

What is the HPA axis of stress?

Answer 22

Hypothalamus release CRH
Stimulates the pituitary gland to release ACTH
Stimulates the adrenal gland to release cortisol
Negative feedback loop

Question 23

What are some public health campaigns in sepsis?

Answer 23

Think Sepsis - health professional awareness and training programme, online interactive game to learn the symptoms
Jason Watkins and Melissa Mead - explain the story of their children and the symptoms of sepsis

Question 24

What are the biological processes that occur during wound healing?

Answer 24

Innate and adaptive immune response to prevent an infection
Formation of a scab to prevent further blood loss
Blood clot forms from platelets, which also release chemokines to attract wbcs.
Platelets dervied growth factor - encourage epithelial and smooth muscle proliferation causing wound contraction.
Wound contraction - tissue from the edge of the wound is pulled inwards to prevent blood loss.
keratinocytes proliferate at the surface of the wound
Fibroblasts secrete new ECM
Angiogenesis - VEGFs, and hypoxia
Repair or regeneration - depending on the cell type and composition of collagen.