Lecture 18: Sepsis

Question 1

What is the definition of systemic inflammatory response/sepsis?

Answer 1

1) temperature38 C
2) pulse>90 bpm
3) respiratory rate>20 or PaCo212,000 or band forms>10%

Question 2

What is severe sepsis?

Answer 2

1) sepsis + hypoperfusion hypotension (SBP 3 sec
- mottled skin
- urine output

Question 3

<p>What is septic shock?</p>

Answer 3

<p>severe sepsis + 1 of the following:

1) ongoing hypotension despite volume resuscitation/fluids
2) need for vasopressors to maintain BP</p>

Question 4

<p>LPS</p>

Answer 4

<p>1) pro-inflammatory

2) Gram negative bacterial membranes
3) immune system responds to LPS without prior exposure
4) systemic injection of LPS can mimic fatal sepsis</p>

Question 5

<p>How are organs damaged in sepsis? </p>

Answer 5

<p>1) impaired perfusion (hypoperfusion)-low BP, high lactate, high glucose, urine output stops

2) impaired oxygen utilization-high lactate
3) coagulopathy-ex. blood oozing from IV sites
4) programmed cell death/apoptosis-ex. urine output stops</p>

Question 6

<p>What causes hypo perfusion? </p>

Answer 6

<p>1) excessive vasodilation-impairs blood flow

2) endothelial dysfunction-results in fluid leakage and tissue edema, capillaries are occluded by coagulation, result cells are further from oxygen containing blood
3) cardiac dysfunction</p>

Question 7

How does hypo-perfusion present?

Answer 7

*HIGH LACTATE=CLINICAL SIGN OF HYPOPERFUSION
Warm shock
1) early when increased cardiac output can compensate for decreased peripheral vascular resistance
2) bounding pulses
3) warm flushed skin, cap refill

Question 8

How do you treat sepsis?

Answer 8

1) Treat the infection immediately
A) diagnostic intervention-blood cultures
B) early antibiotics
C) control infection-drain abscess
2) Resuscitation to optimize perfusion immediately