The deteriorating women

Question 1

What is the leading cause of indirect maternal death?

Answer 1

Cardiovascular disease

Question 2

Infection definition

Answer 2

A pathological process caused by the inflammation of normally sterile tissue or body cavity by pathogenic or potentially pathogenic microorganisms

Question 3

SIRS

Answer 3

A non specific clinical response including 2 or more of the following signs:
- Temperature >38ºC or <36ºC 
- Heart rate >90bpm
- Respiratory rate >20 
  breaths/min 
- WBC >12,000/mm³, 
  <4,000/mm³ or >10% 
  immature neutrophils

Question 4

Sepsis

Answer 4

SIRS + confirmed or presumed infection

Question 5

Severe sepsis

Answer 5

Sepsis + ≥1 acute organ dysfunction

Question 6

Sepsis 6; ‘the golden hour’

Answer 6

Call for help
- High flow O₂ 15l/min, SpO₂ 
  >94%
- Blood cultures (ideally before 
  IV antibiotics) and full clinical 
  examination (to include FBC, 
  U&Es, LFT, CRP, clotting, 
  ABG)
- IV antibiotics as per policy
- IV fluid challenge (lactate ≥2 
  and/or hypotension 
  500mls/15mins - 70kg may 
  require 2l (30ml/kg)
- Serum lactate; if ≥4mmol/l 
  following treatment with 
  sepsis 6 then ITU
- Urine output
CHECK ABOVE WITH PROMPT

Question 7

Sepsis 6; ‘the golden hour’

Answer 7

Call for help
- High flow O₂ 15l/min, SpO₂ 
  >94%
- Blood cultures (ideally before 
  IV antibiotics) and full clinical 
  examination (to include FBC, 
  U&Es, LFT, CRP, clotting, 
  ABG)
- IV antibiotics as per policy
- IV fluid challenge (lactate ≥2 
  and/or hypotension 
  500mls/15mins - 70kg may 
  require 2l (30ml/kg)
- Serum lactate; if ≥4mmol/l 
  following treatment with 
  sepsis 6 then ITU
- Urine output

Question 8

Signs of acute organ dysfunction

Answer 8

- Systolic BP <90mmHg, or 
  MAP <70mmHg
- O₂ required for SpO₂ >90%
- Creatinine >177 or U/O 
  <0.5ml/kg/2hrs (despite 
  adequate fluid resuscitation
- Coagulopathy 9INR >1.5 - no 
  anticoagulation
- Bilirubin >34
- Platelets <100,000/mm³
- Lactate >2mmol/l

Question 9

What should you clinically examine when identifying the source of sepsis?

Answer 9

- Swab of wound/vagina; LVS 
  and HVS
- MSU
- Stool sample 
- Sputum 
- Placental

Question 10

What bloods should be taken from a women with suspected sepsis?

Answer 10

• Serum lactate
• FBC
• Renal and liver function
• C reactive protein
• Clotting studies
• Arterial blood gases

Question 11

What to look at when assessing a women?

Answer 11

A = airway
B = breathing
C = circulation 
D = disability/drugs 
E = exposure 
F = fetus (and everyFing else)

Question 12

Airway assessment

Answer 12

Look:
- Visible obstruction 
- Respiratory effort
- Signs of cyanosis 
- Is breathing paradoxical 
  (chest and abdomen having 
  opposite movements)
Listen:
- Abnormal noises 
- Audible breathing sounds
- 'Wet' sounding speech 
Feel:
- Air movement 
- Signs of Trismus (jaw lock)
If there are obstructions due to vomit, secretions, swelling or spasm; open airway with head tilt, maintain airway and call for urgent assistance

Question 13

Common airway problems

Answer 13

Snoring can usually be solved by positioning
Gurgling needs suction
Stridor call for help
Wheezing tends to be reacting with something, may need inhaler
If no noise of breathing call for help and airway manoeuvres

Question 14

Breathing assessment

Answer 14

• How are they breathing
• Sweating
• Cyanosis
• Use of accessory
• Abdominal breathing
• Equity of chest movement
• Respiratory rate
• Oxygen saturation
  Assess tracheal position and chest expansion

Question 15

Circulation assessment

Answer 15

Look:
- Skin colour/condition
- Pain
- Demeanour
- Oedema 
- Oxygen saturation
- Capillary refill
Listen:
- Patient perception
- Blood pressure
- Heart sound 
Feel:
- Pulse; weak/ thready/ strong/ 
  bounding 
- Oedema 
- Peripheral temp

Question 16

Disability/drug assessment

Answer 16

Look:
- Photophobia 
- Blood glucose
- Pupil size/response to light 
Listen:
- Patient perception of pain
- Orientation; time/space
Feel:
- Reaction to painful stimuli

Question 17

Exposure assessment

Answer 17

Look:
- Rashes 
- Bruises/ lacerations/ haematomas/ wounds/ oedema 
- Drains/ catheters 
- Temperature 
Listen:
- Pulmonary oedema 
- Patient perception 
Feel:
- Oedema 
- Surgical emphysema 
- Skin tugour