Infectious disease emergencies: Therapeutic issues Flashcards
Define sepsis
Clinical evidence of infection
2 or more (qSOFA):
Altered mentation (Glasgow Coma Scale <15)
Respiratory rate ≥22/min
Systolic BP ≤100 mm Hg
Septic Shock
is sepsis with hypotension (systolic BP <90 or >40 fall in systolic BP) persisting despite fluid challenge
Compromisation of intestinal barrier
Peritonitis: release of bacteria into the system
Liver Injury
Impaired detoxification
Impaired coagulation: bleeding and DIC
Altered metabolic response: Glycaemias
Bilirubinaemia: Cholestasis, Jaundice
Acute Respiratory Distress syndrome (ARDS)
Leaky capillaries- compromised oxygen delivery
access route fir secondary Respiratory Infection
Thymic involution
Apoptosis
Impaired T lymphopoiesis
Lymphagitis
abscess
compromised local immune cell function
Encepholopathy
Hypoxic ischaemic brain damage: Coagulopathy
Blood brain barrier dysfunction
Delirium decreased neurotransmitter release
Heart failure
Tachycardia >90, low O2 in blood, hypotension
Defective contractility low Cardiac Output
Splenic Pathology
Splenomegaly
Atrophy of lymphoid follicles
Renal failure
Ischaemia
Bone marrow suppression
Myelosuppression/lymphopaenia
apoptosis of WBCs
Describe the pathophysiology of sepsis.
Excessive inflammation that leads to tissue damage whilst simultaneously having antiinflammatory response that impairs and kills lymphocytes, causing host to be susceptible to secondary infections
with this there is an increase in coagulation and decrease in anticoagulation leading to thrombosis and and vasodilations respectively leading to tissue hypoperfusion
additionally capillaries lose barrier functions due to cell shrinkage which leads to capillary leaks and interstitial oedema
together there is less oxygenation of tissue
How do manage sepsis?
Start approp resus and general support urgently
Inotropic agents
empirc antimicrobials ASAP decreases mortality
Inotropic agents
adrenaline/epinephrine infusions
