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28 Cards in this Set

  • Front
  • Back
bacteremia
presence of viable bacteria in the blood
SIRS
Systemic Inflammatory Response Syndrome

i. Systemic response to a variety of severe clinical insults due to pro-inflammatory cytokines
SIRS criteria
2 or more of the following

-Temperature <98.6 F or >100.4 F
-HR > 90 bpm
-RR > 20 resps/min
-WBC > 12,000 or <4,000 or >10% bands
4 causes of SIRS
1. Pancreatitis
2. Trauma and tissue injury
3. Hemorrhagic shock
4. Ischemia/ reperfusion
sepsis
SIRS related to infection
severe sepsis
sepsis with organ failure, hypoperfusion, or hypotension
septic shock
sepsis with hypotension, despite fluids, along with perfusion abnormalities
MODS
Multiple Organ Dysfunction Syndrome

-presence of altered organ function that can’t be maintained without interventions

-Oxygen delivery < tissue demand leads to ischemic organ damage

-Risk of death ↑15-20% with each organ failure
DIC
Disseminated Intravascular Coagulation

normal balance between fibrin formation and the fibrinolytic system is disrupted and bleeding and thrombosis occur
Pathophysiology of sepsis
Infection

Inflammation
Coagulation
Inflammation
Coagulation
Inflammation
Coagulation

Endothelial dysfunction
Ischemia
Death
4 G + organisms in sepsis
i. S. aureus
ii. Coagulase-negative Staph
iii. Enterococci
iv. Streptococci
6 G - organisms in sepsis
i. E. coli
ii. Klebsiella
iii. Serattia
iv. Enterobacter
v. Proteus
vi. Pseudomonas

LPS in cell membrane are extremely immunologic
7 early S/Sx of sepsis
SIRS
N/V
hyperglycemia
myalgia
lethargy
hypoxia
hyperbilirubinemia
4 early hemodynamics of sepsis
“warm shock”
fever
↑CO
vasodilation
8 late S/Sx of sepsis
Lactic acidosis
oliguria
leukopenia
DIC
shock
TCP
ARDS
coma
4 late hemodynamics of sepsis
“cold shock,
cold skin
↓CO
vasoconstriction
4 lab findings in septic patients
↑lactic acid
low pH
↓ platelets
↑WBC
considerations in Abx therapy in septic patients
i. If life threatening – aggressive therapy
ii. Gram (-) – double coverage/synergy
iii. Septic patients have ↑Vd, Cl
iv. Shifting kidney/liver function
empiric therapy duration
10-14 days
community acquired urinary infection
empiric therapy
ceftazidime, FQ, piperacillin

+/- aminoglycoside
community acquired nonurinary infection
empiric therapy
ceftazidime (+ Metronidazole), Zosyn +/- aminoglycoside
hospital acquired sepsis
empiric therapy
(cefepime or ceftazidime) +/- Metronidazole, Zosyn, imipenem, +/- AG
catheter infection sepsis
empiric therapy
Add vancomycin (until r/o MRSA)
definitive sepsis therapy
based on culture results and patietn response
Protein C is
an endogenous, major anticoagulant
in sepsis, Protein C is
decreased
MoA of drotrecogin alfa
anticoagulant
fibrinolytic
anti-inflammatory (↓ cytokines)
dosing of drotrecogin alfa
continuous infusion x 96 hours