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Flashcards in The deteriorating women Deck (17)
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1
Q

What is the leading cause of indirect maternal death?

A

Cardiovascular disease

2
Q

Infection definition

A

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

3
Q

SIRS

A
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
4
Q

Sepsis

A

SIRS + confirmed or presumed infection

5
Q

Severe sepsis

A

Sepsis + ≥1 acute organ dysfunction

6
Q

Sepsis 6; ‘the golden hour’

A
Call for help
- High flow O₂ 15l/min, SpO₂ 
  >94%
- Blood cultures (ideally before 
  IV antibiotics) and full clinical 
  examination (to include FBC, 
  U&amp;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
7
Q

Sepsis 6; ‘the golden hour’

A
Call for help
- High flow O₂ 15l/min, SpO₂ 
  >94%
- Blood cultures (ideally before 
  IV antibiotics) and full clinical 
  examination (to include FBC, 
  U&amp;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
8
Q

Signs of acute organ dysfunction

A
- 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
9
Q

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

A
- Swab of wound/vagina; LVS 
  and HVS
- MSU
- Stool sample 
- Sputum 
- Placental
10
Q

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

A
  • Serum lactate
  • FBC
  • Renal and liver function
  • C reactive protein
  • Clotting studies
  • Arterial blood gases
11
Q

What to look at when assessing a women?

A
A = airway
B = breathing
C = circulation 
D = disability/drugs 
E = exposure 
F = fetus (and everyFing else)
12
Q

Airway assessment

A
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
13
Q

Common airway problems

A

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

14
Q

Breathing assessment

A
  • 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
15
Q

Circulation assessment

A
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
16
Q

Disability/drug assessment

A
Look:
- Photophobia 
- Blood glucose
- Pupil size/response to light 
Listen:
- Patient perception of pain
- Orientation; time/space
Feel:
- Reaction to painful stimuli
17
Q

Exposure assessment

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