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24 Cards in this Set
- Front
- Back
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Systemic inflammatory response syndrome - definition
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At least 2 of:
High or low temperature HR > 90bpm RR > 20/min Elevated WBCs Immature neutrophils or band cells |
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Systemic inflammatory response syndrome - triggers
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Infection
Trauma Burns Other inflammatory conditions |
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Sepsis - definition
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SIRS with infectious trigger
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Severe sepsis - definition
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At least 1 sign of organ failure with sepsis:
Refractory hypotension Renal insufficiency Hypoxemia Shock liver Marrow suppression Confusion Metabolic acidosis |
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Septic shock - definition
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Sepsis with hypotension despite adequate fluid resuscitation
Organ distress - lactic acidosis, oliguria, acute mental status changes |
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Multiple organ system dysfunction - definition
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Failure of 2 or more organ systems
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Severe sepsis - incidence
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Leading cause of death in non-cardiac ICUs
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Severe sepsis - reasons for increasing incidence
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More invasive techniques that bypass host defenses
More immunocompromised patients More antibiotic resistance More debilitated patients with underlying disease |
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Severe sepsis - mortality
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30-40%
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Severe sepsis - organisms
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Gram positives
Fungi |
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Severe sepsis - clinical manifestations
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Fever
Hypotension Tachypnea and tachycardia Hypoxemia Leukocytosis Irritability and agitation Hypothermia Lactic acidosis |
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Severe sepsis - vascular complications
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DIC - purpura or petechiae
Thrombocytopenia Azotemia Peripheral cyanosis and ischemia, leading to necrosis |
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Severe sepsis - cutaneous lesions
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Ecthyma gangrenosum in gram negative sepsis - pseudomonas
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Severe sepsis - management
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Supportive care - IV fluids, vasopressors, inotropes
Blood products Mechanical ventilation Sedation/analgesia Bicarbonate for acidosis |
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Severe sepsis - diagnosis
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Cultures
Search for and remove infected source |
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Severe sepsis - treatment
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Drain pus
Debride necrotic tissue Antibiotics Insulin for hyperglycemia Corticosteroids in patients with adrenal insufficiency Recombinant protein C - stimulates fibrinolysis and reduces inflammation |
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Gram negative sepsis - common causes
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UTI
Pneumonia Abdominal infection |
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Gram negative sepsis - virulence
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LPS in cell wall
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Gram negative sepsis - signaling cascade
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LPS contacts CD14 surface protein on macrophages and neutrophils
CD4 binds to MD2 and TLR4 Release of cytokines |
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Role of cytokines
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Act on hypothalamus, vascular endothelium, and smooth muscle to cause signs of sepsis
Early phase - excessive inflammatory response Late phase - hyporeactive immune system |
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Gram positive sepsis - virulence
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Peptidoglycan matrix
Teichoic acid |
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Gram positive sepsis - signaling cascade
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Bacterial lipoprotein binds to TLR2
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Gram positive sepsis - organisms
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Staph aureus
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Gram positive sepsis - pathogenesis
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Peptidoglycan activates cytokines, nitric oxide, complement
Lipotheichoid acid binds to TLR2 and activates cytokines Toxins Superantigens |
