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28 Cards in this Set
- Front
- Back
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bacteremia
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presence of viable bacteria in the blood
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SIRS
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Systemic Inflammatory Response Syndrome
i. Systemic response to a variety of severe clinical insults due to pro-inflammatory cytokines |
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SIRS criteria
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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 |
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4 causes of SIRS
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1. Pancreatitis
2. Trauma and tissue injury 3. Hemorrhagic shock 4. Ischemia/ reperfusion |
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sepsis
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SIRS related to infection
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severe sepsis
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sepsis with organ failure, hypoperfusion, or hypotension
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septic shock
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sepsis with hypotension, despite fluids, along with perfusion abnormalities
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MODS
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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 |
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DIC
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Disseminated Intravascular Coagulation
normal balance between fibrin formation and the fibrinolytic system is disrupted and bleeding and thrombosis occur |
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Pathophysiology of sepsis
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Infection
Inflammation Coagulation Inflammation Coagulation Inflammation Coagulation Endothelial dysfunction Ischemia Death |
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4 G + organisms in sepsis
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i. S. aureus
ii. Coagulase-negative Staph iii. Enterococci iv. Streptococci |
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6 G - organisms in sepsis
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i. E. coli
ii. Klebsiella iii. Serattia iv. Enterobacter v. Proteus vi. Pseudomonas LPS in cell membrane are extremely immunologic |
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7 early S/Sx of sepsis
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SIRS
N/V hyperglycemia myalgia lethargy hypoxia hyperbilirubinemia |
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4 early hemodynamics of sepsis
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“warm shock”
fever ↑CO vasodilation |
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8 late S/Sx of sepsis
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Lactic acidosis
oliguria leukopenia DIC shock TCP ARDS coma |
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4 late hemodynamics of sepsis
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“cold shock,
cold skin ↓CO vasoconstriction |
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4 lab findings in septic patients
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↑lactic acid
low pH ↓ platelets ↑WBC |
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considerations in Abx therapy in septic patients
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i. If life threatening – aggressive therapy
ii. Gram (-) – double coverage/synergy iii. Septic patients have ↑Vd, Cl iv. Shifting kidney/liver function |
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empiric therapy duration
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10-14 days
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community acquired urinary infection
empiric therapy |
ceftazidime, FQ, piperacillin
+/- aminoglycoside |
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community acquired nonurinary infection
empiric therapy |
ceftazidime (+ Metronidazole), Zosyn +/- aminoglycoside
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hospital acquired sepsis
empiric therapy |
(cefepime or ceftazidime) +/- Metronidazole, Zosyn, imipenem, +/- AG
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catheter infection sepsis
empiric therapy |
Add vancomycin (until r/o MRSA)
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definitive sepsis therapy
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based on culture results and patietn response
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Protein C is
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an endogenous, major anticoagulant
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in sepsis, Protein C is
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decreased
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MoA of drotrecogin alfa
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anticoagulant
fibrinolytic anti-inflammatory (↓ cytokines) |
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dosing of drotrecogin alfa
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continuous infusion x 96 hours
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