APEARTD

http://www.worcestershireloc.com/useful-resources-for-opticians/ https://cds.bromley.gov.uk/documents/s50063749/App.%201%20to%20Bromley%20Minor%20Eye%20Conditions%20Service%20Pilot%20Update%20CCG.pdf

RECOGNISING SEPSIS The clinical diagnosis of sepsis may be obvious, such as when someone presents to the emergency department with community acquired pneumonia or a perforated viscus; however, in other circumstances and when onset is more insidious the diagnosis of sepsis is often missed. Early diagnosis and prompt treatment is essential as each hours delay in administering antibiotics increases risk of death by close to 8%  (6) . Compliance with international guidelines for the management of sepsis remains low even in countries where the guidelines have been embraced  (7;8) . Sepsis occurs as a result of infection, signs suggestive of infection include: Fever and/or rigors Hypothermia Cough, increased sputum production or dyspnoea Abdominal pain or distension Dysuria, urinary frequency, odour New onset confusion or decreased level of consciousness Recent surgery or invasive procedure with cellulitis or wound infection Line associated redness/swelling/pain Painful sw

Parameters respiration rate oxygen saturation systolic blood pressure pulse rate level of consciousness or new confusion* temperature. inspired oxygen What NEWS does?  • It provides a baseline measure of an individual’s physiological functioning (from a gathered sequence of vital signs recordings);  • It measures the effectiveness of some treatment interventions when there is a change in NEWS;  • It provides a risk assessment of an individual based on recorded observations;  • It can assist in timely escalation of clinical response in the event of an acute physiological deterioration when there is an increase in NEWS. Example Scenario Mr Smith is 52 year old gentleman who attends the emergency department with fever, cough and pleuritic pain with following vitals: Respiratory rate: 21/min Oxygen saturation : 93% On air Systolic blood pressure: 120 mmHg Heart rate : 95/min Consciousness: Alert Temperature: 38.5 °C What is SBAR ?  SBAR

Learning Objectives: 1.   To be able to define sepsis and sepsis 6.  2.   To understand the role of health care assistants in the treatment and recovery of patients with sepsis. 3.   To explore the issues and challenges for those patients who have been diagnosed with sepsis. 4.   To understand the physiological effects of sepsis. 5.   To be able to recognise a septic patient. 6.   To understand and describe the treatment of a septic patient.  What is Sepsis? Sepsis was previously known as septicaemia or blood infection. Sepsis is caused by the abnormal way the body reacts to germs, such as bacteria, entering into your body and developing into an infection. This results in your body attacking and damaging its own organs and tissues which can lead to septic shock, multiple organ failure and death especially if it’s not recognized early and promptly treated and escalated. Sepsis (also known as blood poisoning) is the immune system’s overreaction to an infect

Fig A-  uploaded by  Georg F. Weber The role of IRA B cells in sepsis. During peritoneal infection, Escherichia coli LPS activates innate-like B1a B cells' TLR-4 receptors. After migrating to lymphoid organs, B1a B cells mature into the newly identified IRA B cells. IRA B cells protect against microbial sepsis.  https://www.researchgate.net/figure/The-role-of-IRA-B-cells-in-sepsis-During-peritoneal-infection-Escherichia-coli-LPS_fig1_257753782 Evidence for open abdomen Two randomised controlled trials (RCTs) compared open abdomen with closed abdomen in the management of patients with peritoneal sepsis ( Robledo  et al  2007 ,  van Ruler  et al  2007 ). In one trial, 40 adult patients with severe secondary peritonitis were randomised to receive open abdomen or closed abdomen after intra-peritoneal lavage ( Robledo  et al  2007 ). The mortality in patients with open abdomen was 55% compared to 30% in closed abdomen. However, this difference was not statisti