Syncope and Sepsis Flashcards Preview

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Flashcards in Syncope and Sepsis Deck (26)
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1
Q

Describe the PE of syncope

A
  1. Vital signs
    - Orthostatics: lay down for 3 min then sit up for 3 min then stand
  2. Neck: carotid bruits, JVD
  3. Lungs: rales, crackles (CHF)
  4. Cardiac: new murmurs, irregular heart beat, ectopy, pauses
  5. Abdomen: listen, palpate for AAA,
  6. Extremities: edema, pulses, perfusion, cap. refill
  7. Neurologic:
2
Q

Causes of neurocardiogenic syncope

A

24%

  1. Vasovagal syncope
  2. Situational (coughing postmicturation, defecation)
  3. Carotid sinus
3
Q

Causes of cardiac syncope

A

18%

  1. structural (HCOM)
  2. Arrhythmia (long QT, Brugada, 3rd degree block)
  3. vascular (subclavian steal)
4
Q

Causes of syncope

A
  1. Neurocardiogenic 24%
  2. Cardiac 18%
  3. Orthostatic 8%
  4. Meds 3%
  5. unknown 34%
  6. neurologic 10%
5
Q

Describe the PASSOUT causes of syncope

A
  1. Pressure- vasovagal, orthostatic
  2. Arrhythmia (get EKG)
  3. Seizure (look for tongue or cheek biting)
  4. Sugar
  5. Output- severe AS or MS, MI, dissection
  6. Unusual anxiety, panic attack, hyperventilation
  7. Transient- migraines, head bleeds, TIA
6
Q

Vasovagal syncope is never associated with ___ and most commonly has __

A

exertion

precipitant-standing

**Vasovagal (MC idiopathic)

7
Q

Orthostatic syncope is most commonly in who

A

MC cause in elderly

8
Q

Causes of orthostatic syncope

A
  1. Medications
  2. Volume loss (GI bleed, dissection)
  3. Situational
9
Q

Describe the initial syncope workup

A
  1. HX
  2. PE
  3. EKG
    50% of cases of syncope can be diagnosed with the above. Also consider…
  4. Labs: CBC, CMP, Glucose, Troponins
  5. Imaging: Fast, CXR, Head CT if you suspect head trauma
  6. Guaiac stool
10
Q

Other tests you can consider in the syncope workup include

A
  1. Carotid US (in patient)
  2. Holter monitor (OP)
  3. Tilt table test (OP)
11
Q

Describe the Dispo of syncope

A
  1. Cause directed.
  2. “Low risk patients with single episode of syncope can be reassured without further investigation.”
    - F/U with PCP
  3. Routinely consider admission to the hospital if elderly, hx cardiac disease (including EKG changes or PPM), new anemia, abnormal PE findings.
  4. Use MDCalc–> syncope–> San Francisco Syncope Rule
12
Q

A clinical syndrome that has physiologic, biologic, and biochemical abnormalities caused by a dysregulated inflammatory response to infection.

A

Sepsis

13
Q

Sepsis is more common when

A
  1. in AA males
  2. in Winter months
  3. older pts >65y/o
  4. Increasing rates of sepsis multifactorial. (older populations, Abx over use, immunosuppressed ppl)
14
Q

Describe the MC pathogens that cause sepsis

A

Gram + bacteria (MC in US)

Gram – bacteria (MC w/ GI causes)

Fungal organisms

50% unidentified–> culture neg. sepsis

15
Q

Describe the continuum of sepsis

A
  1. Infection
  2. bacteremia
  3. Sepsis
  4. Septic shock
  5. multiple organ dysfunction Syndrome (MODS)
  6. Death
16
Q

Describe qSOFA

A

*Early sepsis identification for pts OUTSIDE the ICU

RR>22bpm
sBP<100mmHg
Altered GCS

0=Mortality <1%
1= Mortality 2-3%
>/=2 = Mortality >/= 10%

17
Q

Organ dysfunction: “defined as an increase in ___ points in the SOFA score.”

A

two or more

18
Q

Sepsis Risk Factors

A
  1. Age 65 or older
  2. ICU admission –> 50% get hospital acquired infection
  3. bacteremia
  4. Immunosuppression/asplenic
  5. Diabetes
  6. CAP
  7. Prior hospitalization–> Altered microbioms
  8. Genetics
19
Q

Describe the sepsis clinical presentation

A
  1. Hypotension
  2. Tachycardia
  3. Fever >38.3 or <36C
  4. Leukocytosis (not always)
  5. Generally nonspecific
  6. Cool, clammy skin
  7. poor perfusion
20
Q

Describe the sepsis work up

A

Labs:

  1. CBC
  2. CMP
  3. Lactate–> sign of hypoperfusion (>4 can indicate septic shock)

Consider:

  1. ABG (risk of resp. failure)
  2. coags (liver dysfunction/hypoperfusion)
  3. Procalcitonin
  4. Blood cultures

Imaging: as necessary
CXR if pulm. source
CT if suspect GI source

21
Q

How is the sepsis diagnosis made

A
  • Diagnosis often made empirically.

- Constellation of signs / symptoms, lab findings indicative of sepsis.

22
Q

Describe the Tx of sepsis

A
  1. 2 large bore IVs
  2. Cardiac monitor with Q 15 min VS
  3. Fluid resuscitation
  4. Acetaminophen for fever
  5. Early antibiotics (specific for each hospital)
    * Don’t delay Abx for cultures
  6. Admit to the appropriate medical unit.
23
Q

What are factors that can affect the sepsis prognosis

A
  1. Site of infection- UTI better prognosis than unknown, GI or pulmonary.
  2. type of infection- Nosocomial has worse prognosis than community acquired.
  3. Host related
24
Q

What septic infections have the worse outcomes

A
  1. MRSA,
  2. MSSA,
  3. pseudomonas,
  4. polymicrobial,
  5. candida and
  6. non-candida fungal infections have worse outcomes.
25
Q

What are host related factors that can affect sepsis prognosis

A
  1. Failure to develop a fever.
  2. Leukopenia
  3. Thrombocytopenia.
  4. Coagulopathy.
  5. Hyperglycemia
  6. Age
  7. Comorbidities
  8. New onset Afib
26
Q

Sepsis has better outcomes if…

A
  1. Initiate appropriate antibiotics early.
  2. Restore perfusion
  3. Early and aggressive resuscitation
  4. Normalization of lactate.