Sepsis Flashcards
What is systemic inflammatory response syndrome?
Uncoordinated and exaggerated responses of the body to inflammation caused by noninfectious cause
What is Sepsis?
SIRS + infection = SEPSIS
What is Severe Sepsis?
Acute organ dysfunction secondary to documented suspected infection.
What is Septic Shock?
Severe sepsis with hypotension or hypoperfusion that is not corrected with fluid resuscitation.
What do you need to meet SIRS Criteria? (what 4 variables)
2 or more if the following:
- Temp > 38.0 C
- HR > 90 bpm
- RR > 20 breaths/min or PaCO2 < 32 mmHg
- WBCs > 12,000 or < 4,000
What can cause SIRS?
pancreatitis
burns
trauma
ischemia
Diagnostic criteria for sepsis?
Same as SIRS
+
identified/suspected Infection
(PNA, UTI/pyelonephritis, cellulitis, meningitis)
What are some indicators of tissue hypo perfusion or organ dysfunction with sepsis?
elevated lactate AKI (decreased UOP, creatinine increase) acute lung injury bilirubin >2 Plts <100K INR >1.5
What is septic shock? what is the initial volume resuscitation given?
severe sepsis w/ hypotension or hypo perfusion that is not corrected w/ fluid resuscitation
inadequate blood/oxygen supply to meet tissue demand
(30 ml/kg crystalloids is considered adequate volume)
What is multiple organ dysfunction syndrome?
Examples?
Progressive organ dysfunction/failure where homeostasis cannot be maintained without intervention.
Examples: ARDS Liver Failure Renal Failure Encephalopathy/Coma
what is the issue seen in sepsis?
Tissues have higher demand for oxygen and just not able to supply them w/ enough
What occurs when the pro-inflammatory cells outnumber the anti-inflammatory cells?
vasodilation
results in decreased BP
What are the 3 phases of SIRS/Sepsis?
Phase 1: Typical insult -> Balanced response of pro-inflammatory and anti-inflammatory responses
-Vasodilatation
-Leukocyte accumulation
Increased microvascular permeability
Phase 2: Size and/or number of insults increases ->imbalanced response
Phase 3: Multi-organ dysfunction
Who is at risk of sepsis?
Elderly Immunocompromised Chronic illness Malignancy Genetic factors
What are the cardiac effects of sepsis?
decreased L ventricular performance
reduced blood flow to organs
What are the vascular effects of sepsis?
- decrease in capillary fxn
- venous dilation
- endothelial permeability
What are the lung effects of sepsis?
ARDS
Neuro effects of sepsis?
parasympathetic dysfunction
sx:
confusion, agitation
What do you need to do within the first 3 hours of sepsis?
1) lactate
2) obtain blood cultures
3) give broad spectrum abx
4) 30 mL/kg crystalloid for htn
What needs to be done w/in 6 hrs of sepsis?
- vasopressors
- volume resuscitation
- remeasure lactate
What is the primary workup in sepsis and when does it need to be completed by?
Within 3 hours of presentation:
- cbc
- electrolytes w/ BUN/creatinine
- lactate
- PT/INR
- LFTs
What does the secondary workup include?
- UA
- blood cultures (at least 2 different site)
- CXR
- rapid infusion antigen (viral/bacterial pathogen panel)
Where is the highest level of production of lactate found?
Under normal conditions what is it cleared by?
muscle
the liver
What does an elevated lactate indicate in general?
that we are moving away from aerobic to anaerobic, so not providing enough oxygen to the body
