Sepsis Flashcards
SIRS criteria
More than 38C Less than 36c HR more than 90 Respiratory rate more than 20 WBC greater than 12000 WBC less than 4000
Sepsis
Widespread infection coupled with general inflammatory response triggered when infection escapes local control
Septic shock
Distributive shock of bacterial/fungal infection
Typical gram negative bacteria
Severe sepsis is 2 or more of SIRS plus
Hypotension Decreased urine output Positive fluid balance Decreased cap refill Hyperglycemia Change in mental status Rising creatinine in normal kidneys
Micro vascular dysfunction
Increased inflammation Increased coagulation Decreased fibrinolysis Capillary leakage Release of toxins
Hypoperfusion/hypoxia
Micro vascular thrombosis through clotting and release of pro-inflammatory cytokines
Endothelial leakage and breakdown
Organ dysfunction
Global tissue hypoxia
Direct tissue damage
(Organ blood flow clotted off)
The sepsis 6
Give high flow O2 Take blood cultures Give IV antibiotics Start IV fluids Check hemoglobin/lactic acid Monitor accurate urine output
To be completed within 3 hours
Measure lactate level
Obtain blood cultures
Administer antibiotics within 1 hour
Administer 30ml/kg of fluids in 2-3 hours
Lactic acid is a good indicator of
Perfusion to organs
To be completed within 6 hours
Apply vasopressors
Reassess
Death rate of patients who reach septic shock
60%
Clinical manifestations
MAP less than 60
Tachy
Hypotension
Decreased CO
Tachypena, increased depth, wet lungs, ARDS
Cool, clammy, mottled, petichiae, oozing from puncture site, third spacing
More clinical manifestation
Oliguria Increased creatinine Decreased H&H Prolonged bleeding ABGs- acidosis Increased CO2
DIC
Massive clotting cascade Vessel occlusion Tissue ischemia Clotting factors depleted Systemic hemorrhage
