B3.002 - Sepsis Flashcards
What is the older accepted progression of sepsis
SIRS –> Sepsis –> Severe Sepsis –> Septic Shock
SIRS criteria
At least 2 of the 4 of the following:
- Fever or hypothermia
- Tachycardia
- Tachypnea
- Leukocytosis
What is happening in SIRS
Cytokine storm which can cause multiple organ dysfunction
What are the criteria for Sepsis
The same as SIRS plus suspected or proven infection
What are the criteria for severe sepsis
Same as SIRS and Sepsis plus end organ dysfunction in one or more organ systems
What are the criteria for refractory septic shock
All of the above plus lasts for 1 hour despite fluid resuscitation and pressors, may lead to death
What is the continuum now widely accepted of sepsis syndromes
Early sepsis –> Sepsis –> Septic Shock
What is early sepsis
Infection based on clinical suspicion qSOFA score * RR >22 * Altered mentation *Systolic BP <100 mmHg
What is a qSOFA score of <2 indicative of
a 3% risk of mortality
What is a qSOFA score of >2 indicative of
associated with poor outcomes and 18-24% mortality
What is considered Sepsis
Life-threatening organ dysfunction caused by an infection with dysregulated host response
Infection
SOFA score
* increase of 2 or more points
What constitutes septic shock
Vasodilation or distribution problem due to sepsis
Associated with greater risk of mortality
Sepsis
Requirement of vasopressors to maintain a mean arterial pressure of >65
Lactate over 2
>40% mortality vs >10% with sepsis alone
Define shock
Diminished cardiac output or reduced effective circulating blood volume impairs tissue perfusion and leads to cellular hypoxia
What causes shock
Infection
Anaphylaxis
Cardiac abnormality
hypovolemia
What can septic shock progress to
Multiple organ dysfunction syndrome
What is multiple organ dysfunction syndrome
Primary - result of a defined insult
Secondary - result of an indirect insult due to hosts response
No universally accepted criteria - use the SOFA score
Why is sepsis frequency increasing
More aggressive surgery
More resistant organisms
More immune compromise from disease/meds
Increased elderly living with chronic disease
Widespread use of catheters/mechanical devices
Whats the 28 day mortality of septic shock
40-70%
What indicates a poor prognosis for sepsis patients
Increased age Comorbid medical conditions High APACHE II score Elevated lactate Insufficient response to vasopressors Delay in treatment
What are infectious causes of sepsis
Opportunistic infections
Host factors
Indwelling lines/catheters
Microbial factors
Infections that can cause sepsis
Pneumonia Peritonitis Pyelonephritis Absecces Bacteremia Chilangitis Cellulitis and necrotizing fascitits
What is shock
Sudden drop in cardiac perfusion or reduced circulating volume
What can shock lead to
Tissue hypoperfusion and hypoxia
Cell necrosis and eventually organ failure and death if not corrected
What are common classifications of shock
Cardiogenic
Hypovolemic
Septic