sepsis Flashcards
Scenario
Ann had a vaginal delivery with an episiotomy which was shuttered. She had an uneventful postnatal inpatient stay and was discharged home, Ann is now day 5 postnatal and has felt unwell over the last 24 hours and had just been admitted to triage at the local consultant led maternity unit. She is complaining of feeling=no shivery and has severe abdominal is, diarrhoea and vomiting. On admission observations her temperature was 39.5, pulse was 125bpm and blood pressure was 104/ 56,
What is the problem in the scenario
Woman has suspected sepsis
What factors led to this conclusion
She had an episiotomy in delivery.
She is feeling unwell- shivery
Severe abdominal pain
diarrhoea and vomiting
High temp, tachycardia and hypotensive
Demonstrate and discuss how to manage this situation
Introduce myself , ask ann how feeling
press emergency buzzer
Call 2222- obstetric team, charge midwife, microbiologist, anaesthetic, bacteriologist and ensure labs know there is urgent bloods and swabs coming
Give SBAR- recommendations- start septic 6 within first hour of diagnosis
Including three in and three out
3 ins- antibiotics, fluids and oxygen
3 out- blood, urine output and cultures
Remove excess pillows and lie flatter
Apply PPE
AVPU AND ABDCE
Avpu- checking alertness by talking to ann- as she responded she is maintaining her own airway.
AIRWAY
If she was unresponsive i can do a jaw thrust to check is anything is obstruction her airway and do a tongue sweep to get rid of anything, i can also insert a guadel by measuring appropriate size, putting in upside down as a tongue depressor the turning to fir the guadel.
Breathing
Look listening and feeling
Looking fro chest wall movement that is symmetrical
Listening for any striders and wheezing
Felling against my cheek to see if we can feel the breaths
in line with septic 6 protocol administer 15l/min of oxygen through a trauma mask
Circulation
Cannulation- grey cannula on both arms using a septic none touch technique with a sterile dressing that’s dated and timed and flushed by a trained professional.
Then going to take bloods off the back of this- full blood count ( to get haemoglobin, platelets and white cell count), Group and save ( to get blood group) Urina electrolytes ( to check fro kidney function) LFT (liver function test) CRP (check for infection makers) serum lactate ( to check fro lactic acid) Arterial blood gases and blood cultures done by the doctor.
Give antibiotic- Iv broad spectrum as we don’t know the cause of infection currently
Hang a bag of heartmans fluid 500ml/ 30 mins for fluid resuscitation as part of sepsis 6 protocol.
Catheterisation- indwelling, a septic non touch technique, urometer attached to asses fluid output (over 25mls per hour) Obtain a urine specimen and send to labs. Documented on fluid balance chart
Do observations BP, o2( over 96%) pulse (every 5 minutes on a mews chart)
disability
AVPU- asking how she is feeling
Checking her alertness and that she is not unconscious
exposure
check temperature - can give 1g of paracetamol per her weight to help her feel better and document
Check for source of infection- throat swab, sputum sample, check breast incase of mastitis and ask how she feels her boobs are, high and low vaginal swab, rectum swab, stool sample, check perineum and suture (for smell, redness, puss), Tender stomach may mean retained products.
MOVE
Mode of transport- in bed with monitor to asses observations
Oxygen- take a portable tank while travelling
Venous- already have venous access
Expertise- will be in HDU waiting to assist
Documentation
When sepsis 6 was diagnosed and commenced
When help was called
who was called
what they did
when catheterisation and cannulation was done
blood results
swab results
observations on mews chart
fluid balance chart
drugs administered and prescribed
maternal outcome and debrief
Time dated and signed
