Mid Sepsis And Septic Shock

Front 1

What is sepsis?

Back 1

A complex of fever, tachycardia, and tachypnea in association with a local or systemic infection

Front 2

What is severe sepsis?

Back 2

Defined as sepsis with organ dysfunction (hypotension, hypoxemia, oliguria, metabolic acidosis, thrombocytopenia, or obtundation)

Front 3

What is septic shock?

Back 3

Sepsis with concomitant hypotension despite adequate fluid resuscitation and clinical evidence of diminished tissue perfusion.

Front 4

What are the determinants of sepsis syndrome?

Back 4

-Virulence of the organism
-Inoculum of the organism
-Site of infection
-Host response
-Inflammatory-Antiinflammatory balance
-Genetic factors
-Susceptibility
-Regulation

Front 5

What organisms cause sepsis?

Back 5

Mostly bacteria. Since 1986, Gram+ bacteria surpassed Gram- bacteria as the leading cause of sepsis

Front 6

Explain the pathophysiology of sepsis through LPS

Back 6

-LPS initiates the sterotypic inflammatory response
-Initial targets are the macrophage and vascular endothelial cell
-Endothelial: LPS-sCD14 complex receptor
-Macrophage: LPS-LPS-binding protein CD14 receptor
-TLR4 for G-, TLR2 for G+
-Translocation of NFkappaB
-Transcription of TNF
-Factor XII is initiated and bradykinin can be released, which is a potent vasodilator. The complement cascade is activated.

Front 7

In sepsis, what correlated with prognosis?

Back 7

Protein C activity. If protein C drops, mortality skyrockets.

Front 8

How do you describe the shock in sepsis?

Back 8

Distributive/vasodilatory

Front 9

Contrast early and late shock

Back 9

-In early phase shock the BP is low
-In late phase shock the BP is much lower

-In early phase shock the pulse is increased and bounding
-In early phase shock the pulse is increased and thready

-In late phase shock the skin becomes cold and clammy and urine output drops significanly
-In late phase shock blood pH is acidic, pCO2 is down and lactic acid is much higher