Infections, Sepsis, Septic Shock

Question 1

infection

Answer 1

regulated local response to pathogens

• common, non-specific response
• local responses: swelling, heat, pain

Question 2

sepsis

Answer 2

disregulated (over exaggerated) response to pathogents
- systemic response – injury to won tissue

Quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) w/suspected infection:
1. altered mental status
2, RR > 22/min
3. Systolic BP < 100 mmHg

Question 3

Rx - sepsis

Answer 3

1. Early ID and prescription of infection - avoid progress to septic shock
2. start emperic therapy
3. send culture to labe
4. after get results, switch to narrow spectrum Abx

Question 4

septic shock

Answer 4

subset of sepsis and ⇡ mortality
circulatory and cellular metabolism abnormalities
- ⇡ capillary permeability and vasodilation

coagulopathy

• ⇡inflammation
• ⇡ coagulation
• ↓ fibrinolysis (brk down of clots)

Criteria - persisting ↓ BP requiring vasopressin despite fluid replacement
- serum lactate level > 2 mmol/L

Question 5

septic shock symptoms

Answer 5

⇡ HR (SBP < 100 mmHg)
⇡ RR
↓  urine output
⇡ creatinine
⇡ AST, ALT (liver function)
↓  PO2

Question 6

Disseminated Intravascular Coagulation (DIC)

Answer 6

life threatening complication of septic shock
⇡ platelet aggregation -> many mini clots -> organ failure
W/all platelets used up, risk of bleeding

S/Sx - ↓ BP, organ specific issues – leads to MODS, cellular death

Question 7

DIC lab findings

Answer 7

\+ blood culture
leukocytosis + shift to L
\+ lactate
↓ platelets
PT, PTT prolonged
d-dimer: ⇡ fibrin degradation product
⇡blood glucose
other abnormal labs: related to organs

Question 8

meds for DIC

Answer 8

empiric broad spectrum antibiotics
fluids
vasopressors
steroids (anti-inflammatory)
PPIs
Insulin
IV IG to improve defenses
empiric anti-fungal agent