Sepsis Flashcards
Define SIRS
cytokine storm in response to a stimulus leading to multiple organ dysfunction
SRIS criteria
febrile (>38 or 100.4), or hypothermic (<36 or 96,8), tachycardia (>90), tachypnea (>20), leukocytosis or leukopenia (>12,000, <4,000)
Define sepsis
2 of the 4 SIRS criteria plus suspected or proven infection
Define severe sepsis
2 of the 4 SIRS criteria, suspected or proven infection, and end-organ dysfunction in one or more organ systems
Define septic shock
2 of the 4 SIRS criteria, suspected or proven infection, end-organ dysfunction in one or more systems, and severe hypotension (<90 or >40 decrease from baseline) despite fluid resuscitation, requires pressor therapy
Define refractory septic shock
septic shock that lasts for 1 hour despite fluid resuscitation and pressors, this is where patients often die
Define early sepsis (new)
infection based on clinical suspicion combined with RR >22, altered mentation, and/or systemic BP <100, sofa score >2
Define sepsis (new)
life-threatening organ dysfunction caused by an infection with a unregulated host response
Define septic shock (new)
vasodilation or distribution problem due to sepsis causing circulatory, cellular, and metabolic derangements, require vasopressors to maintain arterial BP of >65, lactate >2, 40% mortality vs 10% with sepsis alone,
Define shock
diminished cardiac output or reduced effective circulating blood volume, impairing tissue perfusion, leading to cellular hypoxia, reversible but can be fatal
Causes of shock
infection, anaphylaxis, cardiac abnormality, hypovolemia
Define multiple organ dysfunction syndrome
progressive illness caused either by a defined insult (primary) or as a result of the host response to an indirect insult, no universally accepted criteria, so use the SOFA score
28-day mortality of septic shock
40-70%
patient has a poor prognosis with sepsis if they are experiencing the following:
increased age, comorbidities, high APACHE II score, elevated lactate, insufficient response to vasopressors, delay in treatment
Infectious causes of sepsis
opportunistic infections, host factors such as comorbidities, indwelling devices, especially those leading to the obstruction of normal drainage, and microbial factors that allow infections to evade the immune system and produce toxins we can’t treat
cardiogenic shock
patient has MI, leads to loss of perfusion, reduced circulating volume, hypoxia, necrosis, and ultimately organ failure and death
hypovolemic shock
patient experiences trauma where they lose large volume of blood, leads to reduced circulating volume, hypoxia, necrosis, and ultimately organ failure and death
septic shock
patient has infection where overblown immune response leads to the shunting of blood away from peripheral vital organs leading to hypoxia, necrosis, and ultimately organ failure and death
anaphylactic shock
hypersensitivity leads to over exaggerated immune response against a benign invador leading to the shunting of blood, hypoxia, necrosis, organ failure, and death
toxic shock
bacteria associated with tampons lead to rapidly progressing infection leading to shunting, hypoxia, necrosis organ failure, and death within 48 hours in 65% of patients if left untreated
Catecholamine role in shock
peripheral vasoconstriction due to autonomic nervous system releasing adrenal catecholamines, shunt blood to heart and brain, lead to renal and liver failure, capillary acidosis, and hemodilution with hypovolemia
hemodilution with hypovolemia
when peripheral blood volume decreases, interstitial fluids move into the vasculature to replace this pressure, leading to dilute blood
DIC
disseminated intravascular coagulation, blood pools at site of infection, forms a clot, uses up all clotting factors in the body, leads to profuse bleeding everywhere else
Crepitus
crunching sound indicative of a friction rub between bone and cartilage
