Medical Scenarios: Scenario 2

by Stuart Enoch, PhD

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    00:01 exam. Okay. Slightly different scenario. Twenty nine year old, Crohn's disease, recovering from an emergency laparotomy for perf bowel.

    00:10 These are his observations. SIRS. What are the components of SIRS? What is SIRS? Systemic Inflammatory Response Syndrome? Triad of tachycardia, tachypnea and probably raised white cell count? And-- Temperature. Urine output is not part of the criteria. Temperature, heart rate, white cell count and respiratory rate.

    00:46 Some of the ones I’ve seen have had 6 in them and what have they included.

    00:52 In the exam? No, in some books.

    00:57 This is it. These are crisp guidelines and this is what they are looking for. Yeah now I just need to warn you, I’m sure many of you are revising from books online resources. Many of these online resources are not accurate. So you have to be bit careful.

    01:12 If you are unsure, just refer to the books. You'll be surprised by who has written these questions. Many of them haven't been better at all. Even from established resources, they're just piling the questions. To sell their website, they'll say, I got three thousand questions, four thousand questions. Some of them will be written by anaesthetist and anything, written by random people. And they just put it there because they have to just increase the number of questions. So be a bit careful of this revising online. Books are better.

    01:47 Books are usually proofread, edited, a bit more safer, because I've worked with both and I’m quite surprised with the number of questions that are discussed through the online resource. Because online, they are not really particular about the quality, they just want quantity. They want to say this site has three thousand questions, four thousand.

    02:07 Just competing. So they just put through whatever is coming through without really checking it carefully. So if you're unsure, stop and refer. But I would say, books are bit more safer. Many books have also got mistakes, Part A books. But you need to check.

    02:25 Okay so this is the criteria. Common causes of SIRS. What do you, in surgical patients? Infection, pancreatitis, burns, trauma, pretty much anything can lead to sepsis.

    02:49 So anything can lead to SIRS. Okay, management of a patient manifesting SIRS? It's more of supportive. You need to identify the cause, you need to give supportive treatment.

    03:05 It’s like how you treat a normal infection. This particular patient, you need to go for all of these features, all of these investigations, but it depends on what you are investigating. Okay. Antibiotics. Now the reason I put it right at the end is because would you give antibiotics for every SIRS? No. Yes, that's the thing. So you need to be absolutely, to a bit careful in the exam, not to commit to antibiotics for everyone who is a bit tachycardic.

    03:40 So unless you have something positive cultured, you shouldn't start them on antibiotics.

    About the Lecture

    The lecture Medical Scenarios: Scenario 2 by Stuart Enoch, PhD is from the course Medical Scenarios.

    Author of lecture Medical Scenarios: Scenario 2

     Stuart Enoch, PhD

    Stuart Enoch, PhD

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