Sepsis

Question 1

What are some causes of altered mental health?

Answer 1

• toxins (i.e. alcohol, drugs)
• infections
• psychiatric
• metabolic/ endocrine (i.e. hypoglycaemia)
• G.I
• primary neurological

Question 2

What approach is used on a patient in A&E?

Answer 2

ABCDE approach

Question 3

What does A stand for and when do we know that airways are definitely open?

Answer 3

Airway -> if they can speak

Question 4

What can cause negative airway signs?

Answer 4

• decreased GCS (<8/15)
• excessive secretions
• foreign bodies
• airway swelling
• trauma

Question 5

How can you assess the airway?

Answer 5

• look at chest/ abdomen movements

- listen for noises (partial obstruction) or absent noises (total obstructions)

Question 6

How can you treat obstructions?

Answer 6

1. head tilt and chin lift, or jaw thrust
2. suction to remove debris; basic airway adjuncts
3. interventions (tracheostomy)
   OXYGEN THERAPY MUST BE GIVEN.

Question 7

What is B and what can cause B problems?

Answer 7

Breathing. Causes include…

• decreased GCS
• asthma
• COPD
• pneumonia
• pneumothorax
• PE

Question 8

How is breathing assessed?

Answer 8

• paO2
• RR
• ability to talk in full sentences/ words
• central cyanosis
• symmetry of chest
• tracheal deviation
• percussion + auscultation of chest

Question 9

How can you treat breathing problems?

Answer 9

specific to cause but sit patient up if dyspnoeic

GIVE OXYGEN

Question 10

What is C and what can problems in C cause?

Answer 10

circulation -> circulatory shock (inadequate blood flow which results in damage to body tissues)

Question 11

What are the different types of shock?

Answer 11

• hypovolaemic (due to loss in blood volume)
• cardiogenic (due to heart pump failure)
• distributive (causes vasodilation)
• obstructive shock

Question 12

What are some causes of cardiogenic shock?

Answer 12

• heart failure
• MI
• arrythmia

Question 13

What are some causes of obstructive shock?

Answer 13

• cardiac tamponade (fluid in pericardial sac due to trauma)
• tension pneumothorax
• PE

Question 14

What are the 3 main categories of distributive shock?

Answer 14

• septic (infection causes release of cytokines + histamines -> vasodilation)
• anaphlyactic (histamine release)
• neurogenic (damage to spinal cord)

Question 15

How is circulation assessed?

Answer 15

• colour of extremities
• capillary refill time
• HR
• ECG
• pulse palpation
• BP
• auscultation of the heart
• look for bleeding

Question 16

How are circulation problems treated?

Answer 16

• insert cannulae
• fluid challenge if low BP
• blood transfusions

Question 17

What does D stand for and what do you assess?

Answer 17

Disability
You assess...
- GLUCOSE
- temperature
- ACVPU/ GCS
- pupil response
- pain
- check drug charts

Question 18

What are some problems that can cause a change in disability?

Answer 18

• hypoxia/ hypercapnoea
• drugs
• stroke
• raised ICP
• cerebral hypoperfusion
• metabolic dysfunction (i.e. hypoglycaemia)

Question 19

What is E?

Answer 19

Exposure -> take history, and examine thoroughly. Review reports

Question 20

What can you look for in E?

Answer 20

• rashes
• track marks caused by drug use
• trauma
• cuts/ bleeding

Question 21

What are the signs of hypoperfusion of tissues (caused by hypotension)?

Answer 21

• altered mental health
• mottled/ clammy skin
• oliguria (low urine output)
• tachycardia (compensation)
• elevated lactate

Question 22

Who is at risk of septic shock?

Answer 22

Those with…

• hypoxia
• hypotension
• delirium
• tachycardia

Question 23

Describe the spectrum of sepsis.

Answer 23

1. SIRS
2. Sepsis
3. Severe sepsis
4. Septic shock

Question 24

What is 1) SIRS?

Answer 24

Systemic Inflammatory Response Syndrome

Question 25

How do you diagnose someone with SIRS?

Answer 25

They need to have ≥ 2 of these symptoms: - high temperature (>38 or <36) - high HR (>90bpm) - abnormal WBC count

Question 26

How is sepsis diagnosed?

Answer 26

- SIRS criteria is met | - evidence of infection (blood cultures)

Question 27

How is severe sepsis diagnosed?

Answer 27

- Sepsis with evidence of end organ hypoperfusion/ dysfunction (check lactate + urine output)

Question 28

How is septic shock diagnosed?

Answer 28

Severe sepsis with hypotension despite fluid resuscitation

Question 29

What is the sepsis 6?

Answer 29

``` x3 TAKE - blood cultures - lactate in ABG - urine output x3 GIVE - O2 -> keep sats ≥94% - IV Abx within an hour - Give fluid challenge + monitor BP ```

Question 30

How is lactate a sign of sepsis?

Answer 30

it is a sign of hypoperfusion (the cells are not getting sufficient O2 so have to resort to anaerobic respiration

Question 31

What tests can be ordered to investigate possible sepsis?

Answer 31

- Biochemistry (Blood test) | - Blood culture

Question 32

What can the blood test pick up?

Answer 32

- ⬆️ CRP (acute marker of inflammation) - ⬆️ Creatinine (sign of AKI) - ⬆️ Lactate - ⬆️ WCC

Question 33

What are the pre-renal causes of AKI?

Answer 33

dehydration

Question 34

What are the renal causes of AKI?

Answer 34

- toxins | - glomerulosclerosis

Question 35

What are the post-renal causes of AKI?

Answer 35

- prostrate enlargement | - kidney stones

Question 36

What does the NEWS2 score used for and what does it assess?

Answer 36

It is used for monitoring and escalating. It measures... - O2 sats - Temperature - BP - RR - Pulse - ACVPU scale

Question 37

Name the abdominopelvic regions.

Answer 37

right hypochondriac, right lumbar, right illiac, epigastric, umbilical, hypogastric (or pubic), left hypochondriac, left lumbar, and left illiac divisions

Question 38

What is a diverticulum?

Answer 38

A small pouch that pushes out through the weak spots in the outer layer of the wall of the intestines (usually large).

Question 39

Who is at risk of developing diverticula?

Answer 39

- old people | - people with poor diet

Question 40

What primarily causes diverticula and how?

Answer 40

Insufficient fibre in diet 1. If you don’t eat enough fibre, stools tend to be drier and more difficult to move along the gut. 2. The muscles have go work harder to move the stools and the high pressure that develops can push the inner lining of the gut through to form a diverticulum.

Question 41

What is diverticulosis?

Answer 41

It means that diverticula are present, but do not cause any symptoms or problems.

Question 42

What is diverticular disease?

Answer 42

It is the condition where the diverticula cause intermittent, lower abdominal pain or bloating -> there is no inflammation.

Question 43

What are the symptoms of diverticular disease?

Answer 43

- Bloating - Lower abdominal pain (left lower quadrant) - Bloating - Diarrhoea/ constipation - PR bleeding

Question 44

What conditions present similarly to diverticular disease?

Answer 44

- IBS (though this is more common in young people) | - Early bowel cancer

Question 45

How can diverticular disease be treated?

Answer 45

- High fibre diet - Drink water - Take paracetamol

Question 46

What is diverticulitis?

Answer 46

It is the condition where the ≥ 1 diverticula get inflamed and infected.

Question 47

What can cause diverticulitis?

Answer 47

If faeces get trapped in a diverticulum as the bacteria in the faeces can cause infection.

Question 48

What are the symptoms of diverticulitis?

Answer 48

- Constant pain in the abdomen - Pyrexia - Constipation/ diarrhoea - Blood in stool - Nausea/ vomiting

Question 49

What are the complications of diverticulitis?

Answer 49

- Bowel obstruction - Abscess formation (collection of pus) - Fistula formation (a channel may form to nearby organs) - Perforation of the wall of the bowel -> peritonitis

Question 50

How can diverticulitis be treated?

Answer 50

- Abx for mild symptoms - IV (if vomiting) - Surgery (for complications)