Sepsis and Septic Shock Flashcards
Sepsis and Septic Shock
Chapter 90 CCM 3rd edition
What is the mortality rate in veterinary patients estimated to be?
20-70%
What are PAMPS and DAMPS
Pathogen associated molecular patterns - that bind to pattern recognition receptors (PRRs such as TOL-like receptors) DAMPS= damage associated molecular patterns
Discuss the role of Nuclear factor kB
translocates into the nucleus on PRR binding - results in the production of cytokines (IL-1,IL-6, IL-10, TNFa) also results in activation of caspase 1
What are the mechanisms of coagulation activation during sepsis?
increased TF production mediated thrombin production, impaired fibrinolysis (reduced TFPI, tPA) reduced endogenous anti-coagulants, platelet activation
Discuss the microcirculatory changes
decreased functional capillary density, increased diffusional distance for oxygen, and heterogenous microvascular blood flow all lead to alterations in tissue oxygen extraction and tissue hypoxia.
WHAT IS CRYPTIC SHOCK
Dysregulation of microcirculation before any changes in macrocirculation occur
What causes a loss of vasomotor tone in sepsis?
Loss of regulation between endogenous vasoconstrictors and vasodilators
- over production of NO via increases in inducible NOsynthase by TNFa and IL-1
What are the key strategies involved in sepsis treatment
- Judicious fluid resuscitation
- Source control and acquisition of samples for culture and susceptibility testing
- Early empiric antimicrobial therapy
- Vasopressor and/or inotropic therapy, as indicated
- Physiologic corticosteroid supplementation, as indicated
- Diligent monitoring of vital parameters, physical examination and body weight changes, point-of-care ultrasound, organ function, and laboratory indices
How quickly may blood become sterile in humans following antimicrobials?
within minutes
