week 2 - Shock and sepsis

Question 1

What is shock?

Answer 1

Shock is an inadequate delivery of Oxygen and nutrients to the tissues.

Shock can lead to damaged organs and it is a medical emergency.

Question 2

What are the 5 types of shock?

Answer 2

• Cardiogenic Shock (heart related).
• Hypovolaemic shock (low blood volume).

DISTRIBUTIVE (VASODIALAITIVE SHOCK):

• Septic shock (shock initiated by Sepsis).
• Anaphylactic shock (allergies)
• Neurogenic shock (caused by damage to the nervous system)

Question 3

How is blood pressure maintained?

Answer 3

1) Blood pressure = cardiac output x total peripheral resistance. (BP = CO x TPR)

2) Cardiac output = stroke volume x heart rate (CO= SV x HR)

THEREFORE:

3) Blood pressure = stroke volume x heart rate x total peripheral resistance.

Question 4

How many deaths in the UK are caused by Sepsis each year?

Answer 4

44,000

Question 5

How many hospital admissions in the UK are due to Sepsis, each year?

Answer 5

150,000

Question 6

What percentage of ITU admissions came from the ambulance service?

Answer 6

90%

Question 7

What percentage of Sepsis patients in hospital are bought in by ambulance?

Answer 7

50%

Question 8

What percentage of intensive care beds in England are taken up due to Sepsis?

Answer 8

27%

Question 9

How much do Sepsis cases cost the NHS each year?

Answer 9

£2.5 billion

Question 10

Septicemia VS Sepsis?

Answer 10

• SEPTICEMIA = The presence in the circulating blood of large numbers of disease-producing organisms.
• SEPSIS = The bodies response to large numbers of disease producing organisms in the circulating blood?

Question 11

Sepsis definitions?

Answer 11

• “Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection”
• “Sepsis is a clinical syndrome caused by the body’s immune and
  coagulation systems being switched on by an infection”

Question 12

What are the most likely causes of Sepsis?

Answer 12

ACCORDING TO JRCALC:

• Pneumonia (50% of cases due to this)
• Appendicitis
• Urinary tract infection (UTI)
• Cellulitis or infected wound

Question 13

What is Neutropenic Sepsis?

Answer 13

(complication of cancer
treatment, e.g. chemotherapy)

• Low white blood cell count
  increases the chance of a
  severe infection
• At most risk within 2 weeks
  of treatment, but still for 6-
  8 weeks
• May not be signs/symptoms
  of infection but could be
  very unwell ‘neutropenic’
• Can deteriorate rapidly

Question 13

Who is at higher risk for sepsis?

Answer 13

• Very young or elderly
• Pregnancy
• Diabetes diagnosis
• Immunocompromised
• Recent medical procedures or
  indwelling devices
• Misuse of drugs intravenously
• Skin wounds
• HIV/AIDS diagnosis

Question 14

Clinical symptoms of meningitis/sepsis?

Answer 14

• Fever (may be masked by
  peripheral shutdown or
  antipyretics)
• Cold, mottled skin (especially
  extremities). The skin may rarely
  be warm and flushed; features of
  ‘warm shock’
• Raised respiratory rate and effort.
• O2 saturations - reduced or
  unrecordable (poor perfusion).
• Raised heart rate.
• Capillary refill time >2 seconds.
• Pain in joints, muscles and limbs.
• Rash - progressive petechial rash becoming purpuric - like a bruise or blood-blister. NB
  these rashes are often not present at presentation
• Rigors.
• Vomiting, abdominal pain and diarrhoea.
• Headache.
• Drowsiness/confusion.
• Seizures.
• Photophobia (less common in young children).
• Neck stiffness (less common in young children).

Question 15

Management plan for SEPSIS?

Answer 15

High risk criteria = RED FLAG SEPSIS:

• CABCD approach
• Oxygen (maintain 94-98%)
• IV fluids…
• DO NOT DELAY ON SCENE –
  hospital admission with ATMIST
  and state “RED FLAG SEPSIS”

“The mortality from sepsis increases
by up to eight percent for every hour
that treatment is delayed”