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Flashcards in Sepsis and shock Deck (13)
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1

Define:
a) sepsis
b) septic shock

a) Life-threatening organ dysfunction caused by a dysregulated host response to infection

- Requires two things: infection + organ dysfunction

b) Sepsis + hypotension unresponsive to fluid resus (or requiring vasopressors to maintain MAP > 65)

2

Common sources of infection

Chest, abdo, line, UTU, MSK, CNS, skin

3

Signs of organ dysfunction

- Hypotension (SBP < 90, MAP < 65)
- Hypoperfusion (lactate > 2)
- Hypoxia
- Brain: Confusion, reduced GCS
- Renal: oliguria, creatinine rise
- Marrow: low platelets, raised INR/APTT

4

Screen for sepsis in any patient with NEWS-2 score of what value (or greater)?

5

5

Septic shock: management

Sepsis = BUFALO (within 1 hour)
- Blood cultures
- Urine output
- Fluid resus (IV NaCl 0.9% - 500 ml over < 15 mins)
- Antibiotics (IV)
- Lactate
- Oxygen

Septic SHOCK - will require vasopressors +/- inotropes

6

Shock
a) Define
b) How it leads to cell death
c) Types (plumbing: fluid, pump, pipes)

a) Circulatory failure leading to tissue hypoperfusion

b) Leads to cellular hypoxia and energy deficit, which leads to anaerobic respiration, lactic acidosis and eventually cell death

c) Fluid (hypovolaemic, haemorrhagic), pump (cardiogenic, obstructive), pipes (septic, anaphylactic, distributive - neurogenic, endocrine)

7

Cardiogenic shock.
a) What is it?
b) Causes
c) Management

a) Pump failure

b) Ischaemic (post-MI), arrhythmic

c) Inotropes +/- fluid

8

Obstructive shock.
a) What is it?
b) Causes
c) Management

a) Physical obstruction of the great vessels

b) Tension pneumothorax, massive PE, tamponade

c) Relieve obstruction:
- chest drain
- thrombectomy/ fibinolysis
- pericardiocentesis

9

Neurogenic shock.
a) What is it?
b) Causes
c) Management

a) Loss of vascular sympathetic tone

b) Spinal cord injury, TBI

c) Fluids and vasopressors

10

Hypovolaemic shock.
a) What is it?
b) Causes
c) Management
d) Concealed bleeding - 4 areas

a) Low circulating volume leading to shock

b) Haemorrhage, dehydration, fluid losses

c) - Volume replacement: fluids, blood, etc.
- Arrest the bleeding: TxA, vitamin K/PTC, FFP, etc.

d) - Intra-thoracic
- Intra-abdominal
- Long bones
- Pelvis

11

Anaphylactic shock.
a) What is it?
b) Causes
c) Management

a) Circulatory disturbance due to systemic IgE mediated hypersensitivity reaction

b) Allergies - drugs (eg. penicillin), nuts, latex, bee stings, etc.

c) - Adrenaline IM 500 mcg (1: 1000)
- IV fluid challenge (NaCl 0.9% 500 ml)
- Chlorphenamine IV/IM 10 mg
- Hydrocortisone IV/IM 200 mg

12

Clinical signs of shock

Obs:
- Tachycardia
- Hypotension (late) - or reduction from normal
- Tachypnoea
- Reduced pulse pressure
- Reduced urine output

Clinical:
- Confused/reduced GCS
- Clammy
- Reduced CRT/ cool peripheries

13

68 year old male, admitted with back pain and collapse of sudden onset
a) Diagnosis
b) Management

a) Aortic aneurysm (thoracic/abdominal) UPO

b) A-E approach, crossmatch blood, call vascular surgery