sepsis Flashcards
what is sepsis
infection and systemic inflammatory response syndrome
boundaries for sepsis
temp <36 or >38
rr >20
hr>90
wbc <4 or >12
definition of severe sepsis
hypotension 90/60 or hypoperfusion of one organ -lactate -oliguria -brain function
definition of septic chock
sepsis and vasopressor therapy needed to increase mean arterial pressure to >65 mmHg and lactate to >2mmol/l despite adequate fluid resus
pathogenesis of sepsis
-vasodilation
-oedema
-inability to shut down inflammatory response
-due to recognition of bacteria + recognition of assoc. danger eg tissue damage, trauma
-damage assoc. molecular patterns
-uncontrolled immune response throughout the body not site of infection
-signal 1=PAMP
signal 2=damp
what is innate immunity
- first defect abscence of immune memory eg
- epithelial barrier
- phagocytes
- NK cells
- complement
what are PAMP’s
pathogen assoc. molecular patterns = molecular signature for pathogens eg lipopolysaccharide for gram negative (pink)
what recognises PAMP’s
PRR pattern recognition receptors causing
- endocytosis
- signalling receptors
consequenes of pathophysiology of sepsis
- increased o2 deliver=vasodilation
- coagulation for compartmentalization
- purpural fulminans: blood spots and discoloration of the skin due to coagulated vessels leading to skin necrosis
- multi-organ failure
- immune paralysis so can get 2ndary infection
damage to lungs and heart in sepsis
- myocarditis: inotrops needed
- ARDS due to cytokines to lung alveoli damage
other damage in sepsis
- hypoperfusion
- lactate
- aki
- gut damage
- liver failure
- adrenal necrosis
- pancreas diabetes
- cerveau: autonomuc acth
treatment of sepsis
- recognise
- resus
- refer
recognise sepsis meaning
- Hypoperfusion
- Tachycardia
- Peripheral hypoperfusion: cold skin, cyanosis, skin blotch
- High rr
- Oliguria
- Altered consciousness
- Fever chills
- Hypothermia
- Muscle pains, aching
- Purpura
labs for sepsis
low or high wcc
low platelet due to coagulation
hypoexemia
hypercapnia in later stages
sepsis 6
time one hour give o2 take blood culture give empirical antibiotics measure lactate give fluid measure urine output
