ABCDE and Sepsis Flashcards Preview

Year 3 - Clinical Communication Skills > ABCDE and Sepsis > Flashcards

Flashcards in ABCDE and Sepsis Deck (27)
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1

A

- Is the patient alert and talking to you
- look, look feel, listen for airway obstruction
- medical emergency - oxygen, airway manoeuvres, suction, oro/nasopharygneal airway, bag and mask

2

B

- look - respiratory rate, cyanosis, accessory muscle, chest wall movement
- Feel - percussion, expansion, tracheal deviation
- Listen - lung fields
- Oxygen stats - aim for oxygen above 94%
- consider CXR, ABG, peak flow, nebulisers

3

C

- Assessment - pulse rate/rhythm, blood pressure, heart sounds, perfusion, capillary refill, JVP, oedema
- investigation and intervention - IV access, blood tests, IV fluids, 3/12 lead ECG, ACS
- IV fluid bolus = 500ml (130-154 mmol/L Na+) crystalloid/ <15 min

4

D

5 point disability check
1. AVPU/GCS
2. Pupils
3. Lateralising neurology
4. nick stiffness
5. DEFG - don't ever forget glucose

what does the patient respond to
A- alert
V- voice
P - pain
U - unresponsive

5

E

Expose the patient
- abdomen and focused neurology
- injury and haemorrhage
- joint/calves and for infection
- temperature and antibiotics
- history

6

what is sepsis

- life threatening organ dysfunction caused by a dysregulated host response to infection

7

How do you predict sepsis

- extremes of age
- recent trauma or invasive procedure
- impaired immunity.
- indwelling lines or catheters
- IV drug use
- breaches of skin integrity
- pregnant or recently pregnant

8

What are the high risk for patients with sepsis

- new altered mental state - objective
- RR greater than 25/min or new need for oxygen
- HR 130 BPM or above
- systolic BP <90mmHg or >40mmHg below baseline
- not passed urine in 18 hours
- mottled or ashen appearance
- cyanosis of skin, lips or tongue
- new non-blanching skin rash

9

what are the moderate risk factors for patient with sepsis

- new altered mental state - subjective
- RR - 21-24/min
- HR 91-130bpm or new arrhythmia
- systolic BP 91-100mmHg
- not passed urine in 12-18 hours
- tympanic temperature <36 degrees
- signs of infection at surgical site or wound
- history of acute function deterioration
- impaired immune system
- trauma or invasive procedure within 6 weeks

10

when should you do sepsis 6 management

1. One high risk criteria

2. Two moderate risk criteria and lactate
>2 mmol/L or AKI

3. SBP 91-100 mmHg
and lactate >2 or AKI

11

What is sepsis 6 management

1. Oxygen: target saturations 94-98%
(88-92% in risk of hypercapnic respiratory failure)

2. IV fluid resuscitation

3. IV antibiotics (within 1 hour)

4. Cultures and Source control

5. Blood lactate and blood tests
(Blood gas, FBC, CRP, U/Es + Creatinine, LFTs, Clotting screen)

6. Fluid balance (hourly)

12

what is the antimicrobial therapy that should be given to patients with suspected sepsis

- IV antibiotics within 1 hour
- blood cultures before antibiotics providing <45 min treatment delay
- broad spectrum antibiotics as trust policy if unclear source
- antivirals/antifungals to be considered

13

What are the indicators of organ dysfunction

- acute lung injury
- new altered GCS
- sepsis induced hypotension
- rise in bilirubin
- low platelets
- acute kidney injury

14

What volume resuscitation should you give in sepsis

Immediate IV fluids if SBP< 90mmHg or lactate >2mmol/L2

• IV crystalloid (130-154 mmol/L Na+) bolus 500ml in <15min2

• Up to 30ml/kg for hypotensive patients with frequent
reassessment3

15

When should you escalate a sepsis patient to critical care

- sepsis (or high risk) with systolic BP <90mmHg and/or lactate >4 mmol/L

16

What is septic shock

- sepsis with persisting hypotension despite adequate volume resuscitation (lactate >2mmol/L and vasopressor requirement)

17

what should you look for when assessing the limb

- including colour, temperature, and state of veins

18

what does low diastolic BP indicate

- indicates arterial vasodilation such as sepsis

19

What does a narrow pulse pressure indicate

- Narrow pulse pressure indicates arterial vasoconstriction (e.g. cariogenic or hypovolemic shock)

20

what does each colour mean in terms of the type of blood
- pink
- purple
- gold
- blue

- pink = group and save/x match as appropriate
- purple - FBC
- gold - U+Es, LFTs
- blue - coagulation

21

assume the patient is...

hypovolemic unless cardiogenic shock is suspected

22

What should you do if a patient has abnormal BP

if the patient has a normal BP give a fluid challenge which is a rapid infusion of 500ml of a warm crystalloid (if needed it can be repeated)

23

name the type of volume expanders that you can have

- crystalloid volume expanders
-colloid volume expanders

24

name the crystalloid volume expanders, what it is and what it does

- normal saline/hartmanns solution
- aqueous solution of mineral salts and water soluble molecules
- can cause harm-dilution

25

name the colloid volume expanders, what it is and what it does

- blood, albumin, plasma, gelofusine
- contains larger insoluble molecules such as gelatin
- maintains colloid osmotic pressure in the blood

26

What are the negatives of colloids

- expensive
- can cause coagulopathy
- anaphylactic reaction
- can precipitate cardiac failure
- can cause renal failure

27

What are the negatives of crystalloids

- dilute plasma proteins
- in cases of shock may result in hypoxia
- causes peripheral oedema
- potential for pulmonary oedema