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18 Cards in this Set
- Front
- Back
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Sepsis definition
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Toxic condition resulting from the spread of bacteria or their toxic products from a focus of infection
AKA SIRS w/ infection |
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SIRS
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2 or more of
T > 38.5 or <35 HR >90 RR >20 or PaCO2 <32 WBC >12K, <4K, or > 10% bands |
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Septic shock
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Sepsis + systolic <60
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SIRS causes
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Infection
Tissue damage (ie pancreatitis, burns) Immunologic (lupus, anaphylaxis) Others - thyroid storm |
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Sepsis epi
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Rising incidence
700K cases/US/year Mortality is not improving: 10-30% |
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Sepsis pathogenesis
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Pathogen triggers innate immune response
Tries to contain invader w/coagulation and kill it via cytokine storm SEs: Systemic hypotension - end organ damage Systemic coagulation - DIC |
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Lungs is sepsis
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Frequently get hurt
Acute respiratory distress sydrome |
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Sepsis
the good vs the bad |
Vasodilation
Improves tissue circulation vs lowers systemic BP Increased cap perm Improved immune cell diapedesis vs lower systemic BP Cytokine storm Recruit immune cells vs bystander damage Sympathetic storm Keeps brain and heart perfused vs tissue ischemia Activation of the clotting cascade Wall off damage vs embolism, ischemia |
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What kills you in sepsis?
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Multiorgan failure
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Where did infection start in sepsis
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Pneumonia (40%)
Primary bloodstream (20%) UTI/pyeloneph Cellulitis Peritonitis Other |
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What kind of organisms cause sepsis?
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Gram pos and Gram neg > Fungi
Staph and E. coli are most common pathogens |
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Treating sepsis
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Keep patient alive
Fix the infection -find it, drain pus, give Abx remove lines, caths, devices Address coagulation defects Support organ perfusion ICU, NS IV, norepinephrine |
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Empiric antibiotic therapy in sepsis
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Vanco + something broad
Ceftriaxone, meropenem |
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Pressors
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Norepinenphrine
alpha and beta action - improves pumping and vasoconstricts increasing pressure Dopamine Vasopressin Phenylephrine |
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Giving steroids in sepsis
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Decreases 28 day mortality in
Relative adrenal dysfunction Severe sepsis If given early Maybe |
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How to fix coagulation defect in sepsis
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In severe sepsis can give recombinant activated protein C
Can give in severe sepsis, may decrease 28 day mortality, will also increase risk of bleeding No role in less severe sepsis |
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How to keep the patient with sepsis alive?
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ICU
Mechanical ventilation Tight glucose control Renal replacement Decrease iatrogenic harm by reducing overventilation, using sterile technique Use an algorithim |
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What do you do when a patient has sepsis?
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Start treating/evaluating immediately
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