Sepsis Flashcards
what is SIRS
2 or more of the following
- temp >38, 90
- RR >20,
WBC > 12,000 or <4000
What causes SIRS
Most often infection
then
Pancreatitis, burns, trauma, ischemia other
Sepsis
SIRS with proven infection
Severe sepsis
Sepsis with evidence of
- Organ dysfunction
- Hypotension
- Hypoperfusion
Septic shock
Severe sepsis with
- Hypotension unresponsive to fluid
organ dysfunction in severe sepsis is assessed with SODA
Resp failure CV failure Liver or renal failure Thrombotic dysfunction or Low GCS
The normal innate response includes
PAMPs and DAMPs - LPS in gram negatives
- activate cytokines and immune system
Anti-inflammatory response includes
IL-4, IL-10
IL1R antagonist, soluble TNF-receptor
Release Cortisol
Pro-coagulant response to limit pathogen spread
Sepsis occurs when
The normal immune response becomes self-perpetuating, unregulated and systemic
How is vascular permeability adaptive and maladaptive?
1- adaptive: Increase delivery of PMNs
2- Maladaptive: Hypotension, ARDS
How is Increase platelet adherence adaptive and maladaptive?
1- adaptive: Wall off site of infection
2- Maladaptive: DIC, thrombosis
How is VASOdilation adaptive and maladaptive?
1- adaptive: increase local blood flow
2- Maladaptive: Tissue elsewhere becomes hypoxic, and leads to lactic acidosis
How are anti-inflammatory mediators adaptive and maladaptive?
1- adaptive: limit inflammation
2 - maladaptive: Net state of immunosuppression
Remember that the clinical manifestations of the infectious disease is due to 2 effects
The pathogen
AND the immune system
Treatment of septic shock involves
Abx - AND supportive care
Mortality rate with sepsis
30.5% , 45% require ICU
Severe sepsis accounts for ? admissions
40% of admissions and 45% of deaths
Treating the infection due to sepsis
1- broad spectrum Abx
2- source control -
What is the most common site of infection in severe sepsis
Lung - then abdomen
Always give a broad spectrum Abx first
mortality goes up every 30 mins - speed is the essence
Purpose of early goal-directed therapy
ensure adequate organ perfusion
“early” in early goal-directed therapy
Resuscitation in the ER within 6 hours of presentation
“goal-directed” in early goal-directed therapy
specific targets that are evidence of near-normal function
What 2 drugs can you give in sepsis management
Epi and dobutamine
What adjunctive therapies can you give in septic shock
If >1 hr - despite fluids and pressors
- Give corticosteroids
- Target normoglycemia
- early within 48 hr nutrition
Normal innate immune system response in an infection
cytokines allow increased permeability, increased local blood flow, increased PMNs, complement and antibacterial proteins -
