sepsis Flashcards
reason for more sepsis cases
- better capture
- age
- immunocomprimise
- more resistant bug
sepsis
life threatening organ dysfunction (2 or more qsofa) causes by host response to an infection
qSOFA
RR> 22
DLOC
SBP< 100
septic shock
require a pressor to maintain a MAP> 65 lactate >2
what type of infections are commonly found in RTIs?
gram + and -
what type of infections are commonly found subdiagphamatic
aerobic and gram -
what type of infections are commonly found in UTIs
gram -
what type of infections are commonly found in skin infections?
gram +
what type of infections are commonly found in RTIs?
gram + and -
what type of infections are commonly found in UTIs
gram -
what type of infections are commonly found in skin infections?
gram +
steps of the innate immune response
1- pathogen breaches skin
2- macrophages and mast cells respond to area
3- mast cells cause inflammation
2- macrophages ingest the pathogen and release cytokines
3- cytokines attract basophils/eosinophils/ more mast cells and cause local edema and increased permeability
4- cytokines cause neutrophils to stick to endothelium and invest pathogens at the site, neutrophils die to create pus
steps of adaptive immune response
1- dendritic antigen presenting cells absorb pathogen and present it on its surface
2- the APC enters lymphatic circulation to lymph nodes
3- in the lymph node, the APC attaches to help T cells where antibodies are created
4- If the pathogen itself enters lymphatic tissue, B cells will bind to them and create antibodies
5- T cells will create cytotoxic t cells which enter circulation with the antibody
6- B cell will create effector cells/antibodies
7- cytotoxic T cells and antibodies will travel to the site of infection and either neutralize or tagged them for destruction
SIRS vs Sepsis vs Severe sepsis vs Septic shock vs MODS
SIRS- fever, RR> 20, HR>90, WBC elevation,
Sepsis- 2 SIRS + infection confirmation
Severe sepsis- Sepsis + signs of hypo perfusion (no longer used)
Septic Shock- Severe sepsis refractory to appropriate fluid resuscitation
MODS- Failure of 2 or more organs
SIRS criteria
36> temp> 38 RR> 22 HR> 90 4000> WBC >12000 2 or more to qualify
qsofa
RR > 20
GCS < 14
SBP < 100
2 or more to qualify
types of gram + bacteria
MRSA
Strep
Staf
types of gram - bacteria
space bugs
Ecoli
Salomella
early goal directed therapy
SBP< 90, MAP<65 after 30ml/kg crystalloid , lactate >4
CVP 8-12»_space; give crystalloids to maintain >8
MAP >65»»epi or dope to maintain
SCVO2 > 70»»if less than 70 give PRBC to hematocrit> 30, if SCVO2 < 70 despite SCVO2 > give inotrope to SCO2 > 70
normal lactate clearance
20%/hr
SOFA criertia
Points based on deviation form normal PaO2/FiO2: 400 Plt: 150 liver, bili: 1.2 cardiovascular, MAP: 70 CNS, GCS: 15 renal, creatinine/urine output: 1.2
when are Glucocorticoids recommended in sepsis management
septic shock that is refractory to adequate fluid resuscitation and vasopressor administration
what should you consider prior to starting ABX in sepsis patients
- pt hx ( recent antibiotics received, previous organisms)
- comorbidities (DM, renal failure)
- immunocomprimise
- clinical context (eg, community- or hospital-acquired)
- suspected site of infection
- presence of invasive devices
- Gram stain data
- local prevalence and resistance patterns
ABX therapy in sepsis
Coverage should be directed against both gram-positive and gram-negative bacteria and, if indicated, against fungi (eg, Candida) and rarely viruses (eg, influenza)
what does penicillin do
attacks cell walls
what does fluroquiolone do
attacks dna
what does metronitozol do
reduces bacterial growth
what do myacins do
flows growth of bacteria
