EWS and sepsis and drugs that lead to surgical presentation Flashcards
(21 cards)
what are the different things recorded for EWS?
resp rate, heart rate, BP, oxygen sats, temperature, AVPU and urine output
why is EWS useful?
quick way to score someone for how unwell they are and an easy way to communicate.
can watch to see if a patient deteriorates/progresses
what is the most important parameter of EWS?
Resp rate - good indicator of many different systems
when should you worry about someones heart rate?
when it is outside the range of blood pressure
what is the SOFA score? what is the short version of this?
a score using resp rate, platelets, bilirubin, mean arterial pressure, Glasgow coma scale , creatinine and urine output
qSOFA score is the short hand version:
- resp rate >22 = 1 point
- altered mental state = 1 point
- systolic BP <100mmHg = 1 point
these scoring systems are used for diagnosing sepsis
for a patient with a known infection a SOFA score of 2 indicates sepsis
what is red flag sepsis?
sepsis + red flag symptoms.
how is septic shock defined?
red flag sepsis + lactate >2
what are the red flag symptoms of sepsis?
red flag symptoms include:
- resp rate >25, HR >130, low BP
- need O2, not alert, cyanotic
- low urine output
- neutropenic (chemo in last 6 weeks),
- non blanching rash, mottled.
what is the difference between SIRS and sepsis?
systemic inflammatory response syndrome - deranged acute response to illness - inflammatory markers go up and response is exaggerated and harmful. can be caused by sepsis
sepsis = infection + SIRS
what are the clinical features of sepsis?
general symptoms of infection: tired, fever
SIRS:
- Temperature >38oC/<36oC
- Tachycardia (>90bpm)
- Tachypnoea (RR>20b/min)/PaCO2<4.3kPa
- WBC>12x109/L
- low BP
how do you manage sepsis?
BUFALO
- bloods - FBC (raised WCC), U&E (incase kidney failure), CRP (raised in infection). Also blood cultures ( before Abx given)
- urine output
- fluids
- IV Abx - meropenem
- lactate - if >2 get ITU help
- oxygen- even if they are not desaturating, if they are severe sepsis, give 100% at 15L/m via a non-rebreath mask. (unless COPD)
CXR - if cause is pneumonia
urinalysis if suspect UTI
may need a throat swab or stool culture if still unsure
important to find this source and treat it.
what is septic shock?
sepsis + hypotension despite adequate fluid resuscitation
what drugs lead to surgical problems?
Aspirin/ NSAIDs
steroids
warfarin
COCP
why can aspirin / NSAIDs lead to surgery?
risk of gastric ulcers and bleeding and perforation.
what are the risk factors for NSAID ulceration?
>60yrs previous peptic ulcer type - ibuprofen is safest simultaneous steroid use on anticoagulants
what surgical presentations can warfarin result in?
intraperitoneal bleeding
retroperitoneal haematoma
rectus sheath haematoma
how can COCP lead to a surgical issue?
DVT/ P.E
mesenteric thrombosis and ischaemic colitis
which drugs can cause pancreatitis?
4A, 3Ts, 2S, 1M
alcohol , aminoglycosides, azathioprine, ACE inhibitors
tamoxifen, thiazides, tetracyclines
steroids, sulphonamides
metronidazole
one complication of surgery is ischaemia to part of tissue due to disruption of end arteries. how can this be avoided?
identify end arteries and avoid diathermy or vasoconstriction of these using adrenaline
How can positioning a patient with a chest infection help aid gas exchange?
want to maximise V:Q
perfusion will follow gravity, therefore lie the patient on their side with their good lung down so that this gets more perfused.
if secretions in all of lung - continually keep switching position so by the time the secretions have dropped to that area of lung you move them again so areas with no secretions are perfused
name 2 ionotropes and 2 vasopressors?
vasopressors: NA and vasopressin
ionotropes: Dopamine, adrenaline
