Sepsis Flashcards
old sepsis def?
Clinical evidence of infection, plus evidence of a systemic response to infection
New sepsis def?
life threatening organ dysfunction caused by a disregulatory immune respond to the infection
New way of assessing sepsis severity?
Quick SOFA score:
- tachypnoea
- Low mental status
- low Systolic BP
- (acute)
impairment of any 2 of above suggests sepsis
Spectrum of severity of sepsis?
- Sepsis
- Severe sepsis
- Septic shock
- Multiple Organ Failure
Sepsis def
Clinical evidence of infection, plus evidence of a systemic response to infection.
Severe sepsis def
Sepsis with organ dysfunction, hypoperfusion or hypotension
Septic shock def
Sepsis with hypotension unresponsive to fluid resuscitation
3 vascular changes in microvasculature in sepsis?
- PAF (platelet activating factor): causes increased platelet aggregation and adhesion
- TNFα and C5a: cause increased vascular permeability
- Nitric oxide: causes loss of contractility of vascular smooth muscle
overall outcome of these vascular changes for the tissue?
Occlusion of microcirculation causing hypoperfusion then organ failure
Immune response to sepsis
- increased immune response initially due to TNF, IL-1, IL-6 release
- with time, immunesuppression due to anti inflammatory cytokines, eg. IL-10
Systemic inflammatory response syndrome 4 criteria
– Temp >38 °C or <36°C
– Tachycardia
– Tachypnoea
– WCC > 12 or <4
Sepsis complication
- Systemic inflammatory response syndrome SIRS
- Hypoperfusion
Early sings of hypoperfusion
– Respiratory alkalosis
– Oliguria
Late signs of hypoperfusion
high lactate
long cap refill
Sepsis 6
Give 3: I. O2 II. fluid challenge III. Abx Take 3: I. lactate II. blood culture III. Urine output
