Unit 3 Case 1: Sepsis

Question 1

systemic inflammatory response syndrome SIRS

Answer 1

systemic inflammation
symptoms are fast heart rate (tachycardia), low blood pressure, very low or very high body temperature, very low or very high white cell count

Question 2

sepsis

Answer 2

type of SIRS caused by infection
subsequent systemic inflammatory response
can result in hypoperfusion and dysfunction of major organ groups

Question 3

septicaemia

Answer 3

name sometimes used for sepsis

Question 4

bacteremia

Answer 4

presence of bacteria in the bloodstream

Question 5

the innate immune system is a large part of this case

Answer 5

learn immune response

Question 6

inflammatory response

Answer 6

started by innate immune cells, pro inflammatory cytokines and complement
localise and contain the infection
1.vasodilation and increased blood flow
2.increased vascular permeability
3.release of inflammatory mediators
4.neutrphil chemotaxis
5microvascular coagulation
6.systemic features
7.upregulation of costimulatory molecules

Question 7

5 cardinal signs of inflammation

Answer 7

dolor
calor
rubor
tumor
functio laesa

Question 8

what is cellulitis

Answer 8

bacterial infection of the skin
acute spreading pyogenic inflammation of the dermis and subcutaneous tissue
most commonly from staphylococci and streptococci

Question 9

4 stages of wound healing

Answer 9

hemostasis
inflammation
proliferation
remodelling

Question 10

hemostasis stage

Answer 10

stopping of bleeding by narrowing blood vessels
blood begins clotting by platelets forming a plug held together by fibrin
inflammation begins so the body can heal so blood flow is increased again

Question 11

inflammation stage

Answer 11

overlaps slightly with homeostasis
neutrophils will aid in immune response followed by macrophages

Question 12

proliferative stage

Answer 12

macrophages arrive
collagen is produced, angiogenesis

Question 13

remodelling stage

Answer 13

involves collagen
continuously broken down and produced
to balacne the need for tensile strength and remodelling of new tissue

Question 14

symptoms of sepsis in younger children

Answer 14

blue pale or blotchy skin, lips or tongue
rash that doesn’t fade when you press on it
difficulty breathing, breathlessness or rapid breathing
weak high-pitched cry not like normal cry
fatigue

Question 15

symptoms of sepsis in adult or older child

Answer 15

acting confused
slurred speech
blue pale or blotchy skin lips or tongue
rash that doesn’t fade when pressed
breathlessness or fast breathing or difficulty breathing

Question 16

what will doctors look for in sepsis assessment

Answer 16

fever
low blood pressure
high heart rate
blood tests
electrolyte imbalances
urine, wound and respiratory secretions
x ray or ultrasound

Question 17

what could a blood test be used to identify in sepsis

Answer 17

evidence of infection
clotting problems
abnormal liver or kidney function
impaired oxygen availability

Question 18

what is sepsis 6

Answer 18

3 diagnostic and 3 therapeutic steps to be delivered within one hour of initial diagnosis of sepsis
ensure a senior clinician attends

Question 19

what does the sepsis 6 include

Answer 19

give high-flow oxygen
give IV antibiotics
give a fluid challenge
take blood cultures
measure lactate
measure urine output

Question 20

gram negative bacteria

Answer 20

more difficult for uptake of nutrients as it has 2 membrane layers
cytoplasmic membrane and outer membrane
one peptidoglycan layer

Question 21

gram positive bacteria

Answer 21

thick peptidoglycan layer
cytoplasmic membrane
more rigid
stronger cell wall

Question 22

gram negative bacteria stains

Answer 22

stains red
thin layer of peptidoglycan and the dye will leak out and stain cell red
diderms

Question 23

gram positive bacteria stains

Answer 23

stains purple
thick peptidoglycan layer
retains dye
monoderms

Question 24

normal blood pressure

Answer 24

120/80 mmHg

Question 25

normal heart rate

Answer 25

60 to 100 bpm

Question 26

normal respiratory rate

Answer 26

12 to 16

Question 27

normal o2 saturation

Answer 27

96% equal or higher

Question 28

normal body temperature

Answer 28

36.1-38

Question 29

GCS

Answer 29

assess wakefulness and awareness to determine consciousness lower value the less conscious AVPU scale scored up to 15

Question 30

itu monitoring

Answer 30

pain urine output consciousness temp pulse resp rate spo2

Question 31

role of the paramedics in the emergency department

Answer 31

ambulance pre alert the ED if transporting patient needing to be received by a clinical team patients are received by an appropriate medical team upon arrival paramedics manage treatment until this point

Question 32

triage

Answer 32

patients who are unheralded then seen by a triage nurse on arrival assess severity of the condition

Question 33

NHS major incident triage tool

Answer 33

catastrophic bleeding walking breathing responds to voice aged over 2 breathing rate 12-23 heart rate 100 or more answers lead to ranking of severity

Question 34

MDT involved in emergency departments

Answer 34

consultants registrars hospital medical officers nurse practitioners physiotherapists emergency department pharmacists mental health emergency team admin staff

Question 35

drugs involved in this case

Answer 35

flucloxacillin co-amoxiclav

Question 36

flucloxacillin

Answer 36

narrow spectrum type of penicillin beta lactase antibiotic gram positive bacteria in skin and soft tissue infections contains beta lactam ring brand name: floxapen, fluclox

Question 37

co-amoxiclav

Answer 37

broad spectrum type of penicillin beta lactase antibiotic mix of clavulanic acid and amoxicillin should be reserved for infections likely caused by beta lactase producing strains egg, influenzae, s aureus gram positive and negative brand name: augmentin, clavulin

Question 38

flucloxacillin mechanism of action

Answer 38

binds to transpeptidase, penicillin binding protein inside bacterial cell wall inhibits 3rd and last stage of bacterial cell wall synthesis prevents PBPs from cross-linking D-ala-D-ala chain on a tetra peptide cross linking of peptidoglycan walls fail to happen, walls are weak, cell lyses occurs by autolytic enzymes called autolysis hydrolyse mucopeptide polymers in bacterial cell wall if they attempt to divide, cell walls will collapse and kill them in the process

Question 39

co-amoxiclav mechanism of action

Answer 39

amoxicillin binds to transpeptidase prevents PBPs from cross-linking with D-ala-D-ala chain cell lyses occurs clavulanic acid prevents beta lactamases from breaking down amoxicillin by binding to it

Question 40

side effects for penicillins

Answer 40

D&V nausea skin reaction hypersensitivity thrombocytopenia

Question 41

side effects of flucloxacillin

Answer 41

gastrointestinal disorders allergy presenting as a skin rash anaphylactic reactions, hypotension, bronchospasm, orofacial,pharyngeal and laryngeal oedema, liver toxicity

Question 42

side effects of co-amoxiclav

Answer 42

increased risk of infection dizziness, dyspepsia, headache colitis haemorrhagic, crystalluria, hypersensitivity vasculitis, meningitis aseptic

Question 43

sampling and testing pus by gram staining

Answer 43

5ml pus using sterile syringe smear onto microscope slide and spread with a sterile loop fix using methanol apply crystal violet and iodine then acetone or ethanol apply stafranin view under microscope

Question 44

results of gram staining with pus

Answer 44

positive= purple negative= pink cocci= round bacilli=rod

Question 45

catalase testing

Answer 45

differentiates between staphylococci and streptococci is an enzyme produced by microorganisms that mediates breakdown of hydrogen peroxide into oxygen and water to prevent oxidative damage to microorganisms if effervescence then enzyme is present

Question 46

catalase testing results

Answer 46

staphylococcus is catalase positive streptococcus is catalase negative

Question 47

coagulase test

Answer 47

staphylococcus aureus produces coagulase enzymes converts fibrinogen in blood plasma to insoluble fibrin coats bacteria protects them from phagocytosis

Question 48

coagulase test results

Answer 48

staphylococcus aureus tests coagulase positive any other staphylococci will test coagulase negative

Question 49

mannitol testing

Answer 49

based on the presence of sodium chloride inhibits most gram negative and positive differentiation based on ability or not to ferment the mannitol if fermentation induces acidification which leads at pH levels below 6.9 to yellow colouration of medium in presence of phenol red

Question 50

mannitol testing results

Answer 50

if mannitol positive (ferments the sugar) likely to be S.aureus

Question 51

antimicrobial sensitivity testing

Answer 51

uses agar plates with antimicrobial discs measure the zones of inhibition to calculate efficacy of drugs or resistance of bacteria

Question 52

treatment options for sepsis

Answer 52

beta lactam/beta lactase inhibitor combinations prevents active beta lactam from being hydrolysed so can still inhibit transpeptidases

Question 53

public health involvement for sepsis

Answer 53

CDC get ahead of sepsis uk sepsis trust sepsis 6 NEWs

Question 54

factors that may link to sepsis mortality

Answer 54

low income high poverty lack of health insurance lower education status access to healthcare

Question 55

factors contributing towards mental health

Answer 55

social isolation or loneliness social disadvantage, poverty or debt severe or long-term stress having a long-term physical health condition unemployment or losing job childhood abuse, trauma or neglect substance misuse homelessness or poor housing long term caring for someone

Question 56

factors affecting mental health in this case

Answer 56

relationship strains redundancy form job long-term stresses lack of work-life balance zero hour contract

Question 57

blood test results for iron deficiency anaemia

Answer 57

Hb: normal at first but will fall as anaemia worsens RBC size/ MCV: may be decreased RBC amount/ MCHC: may be decreased RBC variation in size: increased

Question 58

further tests a doctor may do to confirm iron deficiency anaemia

Answer 58

serum iron total iron binding capacity transferrin saturation index ferritin

Question 59

blood test results for pernicious anaemia

Answer 59

low Hb level MCV often high

Question 60

blood film results for pernicious anaemia

Answer 60

abnormally large RBCs abnormal shaped RBCs occasional giant white blood cells

Question 61

other tests for pernicious anaemia

Answer 61

vitamind B12 folic acid level methylmalonic acid homocysteine reticulocyte count antibodies to intrinsic factor or parietal cell antibodies sometimes a bone marrow aspiration

Question 62

blood test results for aplastic anaemia

Answer 62

haemoglobin may be low RBC and WBC counts are low platelet count is low MCV may be normal or slightly raised differential white blood cell count shows decrease in most types of cells but not lymphocytes

Question 63

additional testing for aplastic anaemia

Answer 63

reticulocyte count erythropoietin bone marrow aspiration tests for infections such as hepatitis,EBV, CMV test for arsenic iron tests for vitamin B12 antibody tests for ANA

Question 64

pure red cell aplasia

Answer 64

only red blood cell precursors are absent

Question 65

testing for haemolytic anaemia

Answer 65

test for haemoglobin variants such as haemoglobin electrophoresis DNA analysis G6PD test osmotic fragility test