Sepsis Adults Flashcards
what is sepsis
life threatening organ dysfunction caused by a dysregulated host response to infection
what is septic shock
subset of sepsis, underlying circulatory and cellular and metabolic abnormalities lead to substantially increased mortality risk
characteristics of sepsis
TODE
threat to life
organ dysfunction
dysregulated host response
evidence of infection
most common underlying cause of sepsis
infections
injuries, non-communicable diseases
leading cause of global incidence of sepsis
diarrheal diseases
leading cause of global incidence of sepsis related deaths
lrti
pathogenesis of sepsis
pamps = initiators
cytokines = tissue damage and necrotic cell death = damps = endothelial dysfunction, coagulation activation, complement activation
lactate production
leads to organ dysfunction and decreased oxygen delivery
risk factors for sepsis
predisposition to develop infection
progression from infection to organ dysfunction
extremes of age, male, african race
host factors that affect host response
pro inflammatory reactions = collateral tissue damage
anti inflammatory responses = susceptibility to secondary infection
characteristics of ards
hypoxemia and bilateral infiltrates of non-cardiac origin that arise within 7 days of infection
classification of ards
mild 201-300
moderate 101-200
severe <100
important differential for respiratory failure in sepsis
hydrostatic edema secondary to cardiac failure or volume overload
presentation of cardiac injury in sepsis
hypotension hypovolemia diffuse capillary leakage reduced systemic vascular resistance depressed myocardial function
sequence of events in cardiac injury in sepsis
early sepsis (shock): reduced volume status, low svr, low co --> volume repletion occurs
result: low svr and high co
aki is documented in ___ septic patients
more than 50%
increases risk of hospital death by 6-8 fold
occur in 25% in the absence of overt hypotension
manifestations of aki
oliguria, azotemia, rising serum creatinine (needs dialysis)
pathophysio of aki
- diffuse microcirculatory blood flow abnormalities
- inflammation
- cellular bioenergetic responses to injury
typical cns dysfunction in sepsis
coma or delirium with no focal lesions
eeg: non-focal encephalopathy
diffuse cerebral dysfunction caused by inflammatory response to infection without evidence of primary cns infection
sepsis associated delirium
delirium screening tools
confusion assessment method for the icu
intensive care delirium screening checklist
post sepsis neurological complications
critical illness polyneuropathy and myopathy
adrenal dysfunction in sepsis is related to ___
reversible dysfunction of hypothalamic pituitary axis or tissue glucocorticoid resistance
t/f there is a standard diagnostic test for sepsis
false, no test
criteria for sepsis
- suspected (or documented) infection
- acute increase in >/= 2 sepsis related organ failure assessment (sofa) points
criteria for septic shock
- suspected (or documented) infection
- vasopressor therapy to maintain map >/= 65 mmhg
- serum lactate >2.0 mmol/l
sofa scoring
read
> /2 sofa points is septic, >/=10% risk for in hospital death
components of qsofa
rr >/= 22
sbp less/= 100 mmhg
altered mental state
management of sepsis
- immediate resuscitation (map >/= 65 mmhg with normal lactate <2.0)
- iv antibiotics within 1 hour
- stat blood culture before antibiotics
- respiratory support (peep)
a guideline to decrease significantly sepsis patients’ mortality
surviving sepsis guideline
points of emphasis in care of septic patients
- act quickly (within 1 hr)
- minimize time to treatment
- monitor closely
1 hour bundle initial resucitation
1: measure lactate, remeasure after resuscitation or when initial lactate levels is elevated (> 2mmol/l)
2: stat blood cultures before antibiotics
3: broad spectrum iv within 1 hour
4: stat administration of 30 ml/kg crystalloid for hypotension or lactate levels >/= 4 mmol/l
5: if no response, give vasopressors to maintain map >/= 65 mmhg
