Exam 3 - Harris - Sepsis Flashcards
What is infection?
Inflammatory response to microorganisms or invasion of normally sterile tissues
What is SIRS?
Systemic response to a variety of process
Systemic Inflammatory Release Syndrome
What is sepsis?
Infection
AND
> /= SIRS criteria
What is severe sepsis?
Sepsis
AND
Organ dysfunction
What is septic shock?
Sepsis
AND
Hypotension despite fluid resuscitation
AND
Perfusion abnormalities
- Lactic acidosis
- Oliguira
- Acute alteration in mental status
What is MODS?
Multiple Organ Dysfunction Syndrome
Altered organ fx in an acutely ill pt
Homeostasis cannot be maintained w/o intervention
What are 4 criteria for SIRS?
Temp - >38C or <36C
HR - >90 bpm
RR - >20
WBC - >12,000 or <4,000 or >10% bands
2020 estimated sepsis cases in US?
2 million cases/year
19 million cases worldwide
Who gets sepsis?
- Anyone
- Common with pre-existing diseases
- US G- most common, but since 2000s, G+ are more common
- Worldwide
- 62% G-, 47% G+, 19% fungal
Signs of hypotension.
<90 mmHg
Hypo-perfusion
MAP (Mean arterial pressure)
-SBP + 2(DBP)/3
—SBP - Systolic BP
—DBP - Diastolic BP
What is the progression of sepsis?
Infection/trauma
SIRS
Sepsis
Severe sepsis
What is sepsis?
Clinical syndrome that results from a dysregulation inflammatory response to infection
Pt w/ continued hypotension or high lactate level
-After a fluid bonus - 10-30 mL/kg
Hypotension is often associated with organ damage or dysfunction (MOF)
Multiple organ dysfx.
Primary
-Result of a well-defined insult
—Renal failure from muscle breakdown products - Rhabdomyolysis
Secondary
-Due to host’s response
What are some markers of severe sepsis?
Altered consciousness Tachypenea Jaundice High enzymes Low albumin Tachycardia Hypotension High troponin High creatinine Low platelets
What is ischemia?
Decreased O2 given tissue needs
What is cytopathic injury?
Inflammatory mediators cause damage
Where is the fluid in an edematous state?
Interstitial fluid
Pro-inflammatory cytokine?
TNF-alpha
Anti-inflammatory cytokines?
IL-4, IL-10
T/F - W/ sepsis, if correct antibx are given w/in 2 hours, the mortality rate is less than 40%. If at 36 hours, rate is 100%.
TRUE
What do we do for sepsis?
Fluids
Pressors
Monitor tissue perfusion
Tx of sepsis?
Data
ABCs normal
Monitor tissue perfusion
Vasopressors
Source control
Monitor response to therapy
*ICU prophylaxis, nutrition, PT
What is bacteremia?
Presence of viable bacteria in the blood
Bacteria that cause sepsis?
Strep>strep viridans (alpha-hemo)>strep beta>anaerobic mixed>Staph aureus (MRSA and MSSA) and fungal (candida and sacchromyces)
Why more cases of sepsis than in the past?
People living longer
AND
Ability to help the immunocompromised live longer
Organs/organ systems that show various clues to the presence of organ dysfx?
CNS: Altered consciousness, confusion, psychosis, delirium
Respiratory: Tachypnea, hypoxemia, decreased O2
Liver: Jaundice, increased liver enzymes, hypoalbuminemia
Cardiovascular: Tachycardia, hypotension, increased venous pressure
Kidney: Oliguira/anuria, increased creatinine
Hematological:
Tx of myocardial dysfx in septic shock?
Abx therapy
AND
Surgical removal of infectious focus
SIRS can result from what?
Pancreatitis
Trauma
Burns
Other
*This can turn into sepsis
How to monitor tissue perfusion?
Clinical assessment
- Skin
- Urine output
- MSE
pH and lactate
- Hypoxic - anaerobic production of lactate, global w/ shock or local w/ bowl infarction
- Ahypoxic - Decreased clearance of lactate or accelerated aerobic glycolysis
