Micro: Septic Shock Flashcards
What are the 5 clinical syndromes in the progression of infectious dissemination?
- Systemic Inflammatory Response Syndrome (SIRS)
- Sepsis
- Septic Shock
- Severe Septic Shock
- Multi-Organ Dysfunction Syndrome (MODS)
When is a patient considered to be in a state of SIRS?
Must meet 2 out of 4 criteria:
- Oral Temp greater than 38C or less than 36C
- Resp. Rate greater than 20bpm or arterial CO2 conc. less than 32 torr (1 torr = 1 mmHg)
- HR greater than 90 bpm
- WBC count greater than 12000/uL or less than 4000/uL or greater than 10% band cells.
What are band cells?
Band cells are used to define inflammation. They are immature white blood cells identified on microscopy as having a curved or “band-like” nucleus. Normally band cells make up about 3-5% but when band cells exceed 10% it indicates a large immune response because many new WBCs are being created.
When is a patient considered to be in sepsis?
SIRS + confirmed (or suspected) infection
When is a patient considered to be in severe sepsis?
Sepsis + hypotension -systolic BP less than 90 or -40mmHg less than patient's baseline SBP -can be corrected by administering fluids
When is a patient considered to be in septic shock?
Sepsis + persistent hypotension (irreversible)
- organs start to show dysfunction
- altered mental status
When is a patient considered to be in MODS?
Sepsis + altered organ function
-includes organ failure
Most common cause of sepsis.
Bacterial
5 most common bacteria that cause sepsis.
Gram (+) 1. Staph aureus 2. Strep pneumo Gram (-) 1. E. coli (nosocomial) 2. Klebsiella pneumo (nosocomial) 3. Pseudomonas a. (burns)
Agents most likely to cause sepsis in neonates.
Early onset: S. agalactiae, E. coli, H. flu, Listeria
Late onset: S. epidermidis, S. aureus, E. coli, Klebsiella, Pseudomonas, Candida
3 bugs that cause sepsis in infants.
S. pneumoniae, N. meningitidis, H. influenzae
What are risk factors for acquiring Gram (+) cocci sepsis?
- inserted mechanical devices
- skin wounds (burns, IV drug abusers)
- toxins
Bacterial components that cause septic response by the host immune system. (gram + and gram -)
Gram (+) -Peptidoglycan, Teichoic Acid, Superantigen Gram (-) -LPS -LOS for Gram (-) cocci: Neisseria sp.
Which Gram (+) cocci produce a superantigen?
S. aureus: TSST
S. pyogenes: pyrogenic exotoxin (doesn’t cause shock)
What condition increases the risk of Salmonella infection leading to sepsis?
Sickle Cell disease
