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27 Cards in this Set
- Front
- Back
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Sepsis
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SIRS due to infection
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SIRS- systemic inflammatory response syndrome
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2 or more of the following:
-Temp >38 C, <36 C -HR >90 -Resp >20/min or PaCO2<32 mmHg -WBC >12,000 cells/m3, or <4000cells/ml, or >10%band PMN |
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Sepsis Syndrome
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Sepsis + evidence hypoperfusion/organ dysfnx + one of the following:
-mottled skin -hypoxemia -elevated lactate -oliguria -mental status change (abrupt) -abnormal EEG -low platelets -DIC -acute lung injury -cardiac dysfnx |
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Septic Shock
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Sepsis Syndrome + hypotension despite fluid resuscitation which may require vasopressors
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Bacteremia
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viable bacteria in blood, confirmed by culture; may be transient
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Septicemia
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severe bacteremia
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MODS- multiple organ dysfnx
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presence of altered organ fnx in an acutely ill patient such that homeostasis cannot be maintained without intervention
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bacterial agents of sepsis:
community-acquired pneumonia |
Streptococcus pneumoniae
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bacterial agents of sepsis:
deep tissue wound |
Bacteroides, Clostridium, other anaerobes
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bacterial agents of sepsis:
UTI |
E. coli, Klebsiella, other Gram negative bacteria
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bacterial agents of sepsis:
infection from intravascular device |
Staphylococcus areus, coagulase negative Staphylococci
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bacterial agents of sepsis:
severe burns |
Pseudomonas
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Common Bacterial Agents of Sepsis
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Gram negative rods
Encapsulated pyrogens Staphylococci Beta-hemolytic streptococci Anaerobes |
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Special considerations for Pseudomonas aeruginosa
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-Gram negative bacilli
-Ubiquitous; opportunistic pathogen -Oxidase + -Pigments & toxins -Burn victims, hot tubs, cystic fibrosis (URI) |
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Sepsis due to Pseudomonas infection . . .
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-Immunocompromised patient
-Neutropenic patient -Higher mortality rate -Special consideration for antimicrobials- resistance |
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Ecthyma gangrenosum lesion
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Characterisitic for pseudamonas infections… kill endothelia cells and sub Q vessels
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Factors that predispose to sepsis and septic shock
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-Alteration in host defenses
-Severe underlying illnesses -Major surgery -Presence of foreign bodies -Obstructive process -Treatment with cytotoxic or anti-metabolites -Prior antibiotic therapy -Prolonged hospitalization; invasive procedures |
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Cardiovascular and Hemodynamic aspects of sepsis: SVR and CO
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Initial vasodilation and capillary leakage result in decreased SVR; compensatory cardiac output
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Cardiovascular and Hemodynamic aspects of sepsis: Hypotension
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Marked hypotension initially responsive to volume replacement; later becomes refractory
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Cardiovascular and Hemodynamic aspects of sepsis: CV insufficiency
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Generalized CV insufficiency due to vascular and myocardial abnormalities, from maldistribution of blood, endothelial damage, and hypoperfusion
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Cardiovascular and Hemodynamic aspects of sepsis: Coagulation
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Coagulation abnormalities with organ damage
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Septic shock coagulopathy
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-Increased pro-coagulant state
-Decreased fibrinolysis -DIC -Fibrin deposition in small blood vessels and microvascular thrombosis in critical tagretorgans leads to organ failure. -Consumption of clotting proteins may lead to bleeding , thus both clotting and bleeding can occur simultaneously |
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Endogenous mediators of sepsis
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TLR 4
TNF-a IL-1 IL-6 NO Kinins PAF PGs Complement Coag Factors |
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Patient Management in Sepsis
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-AGRESSIVE VOLUME REPLACEMENT
-Tissue oxygenation -Immediate empirical anti-microbial therapy -Drainage of localized infection -Re-evaluate and focus aM therapy -Vasopressors and Inotropics if fluid replacement doesn't increase BP -corticosteroids, insulin |
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Blood cultures for suspected sepsis patients
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2-3 sets of cultures w/in 24hrs, optimally 20-30ml
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Early events in sepsis
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-Vasodilation, decreased PR & increased CO
-Fever -Flushing -Capillary leakage, reduced volume (shock) -Hypotension -Temp irregularity -Lactic acidosis -Hyperglycemia -Coag defects -microvascular circulation changes of various organs -**Hypoperfusion** due to above |
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ARDS in sepsis
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acute respiratory distress syndrome: marked increase in dyspnea and hypoxia
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