Sepsis & septic shock Flashcards
What is the mortality from sepsis & septic shock?
- Sepsis - 20%
- Septic shock - 40%
What is sepsis?
Life threatening organ dysfunction caused by dysregulated response to infection
What is sepsis definition based on SOFA scoring ?
Increase in SOFA score by 2 points
What is septic shock?
Organ dysfunction requiring vasopressor support to maintain MAP > 65mmHg and lactate > 2mmol/L
Substances produced by micro-organisms in sepsis?
- ## Cytokines - Endothelial & WBC
What kind of inflammatory processes are components of sepsis?
- Pro-inflammatory
- Anti-inflammatory
Patient factors in response to sepsis?
- Genetics
- Age
- Chronic conditions
- Medications
What are the pathogenic factors in response to sepsis?
- Load
- Virulence factor
Meningococcal & staphylococcal presentation ?
Both have a typical clinical presentation
Components of the pro-inflammatory pathway ?
- Organ damage
- Multi-organ dysfunction
- Organ failure
Endothelium activation in sepsis leads to the following?
- Expression of adhesive molecules, WBC adhesion & activation of neutrophils
- Expression of tissue factors leading to pro-inflammatory effects
- Expression of NO leading to vasodilation
- Increased capillary permeability
Macrovascular changes in sepsis?
- Hypotension
- Loss of intravascular volume
What is Noradrenaline?
Potent alpha-1 agonist
Microvascular changes in sepsis?
- Micro-thrombi
- Impaired oxygen exchange and delivery
- DIC
- Thrombo-embolic complications
Cytopathic hypoxia?
Oxygen utilization is impaired at a mitochondrial level
The pro-inflammatory & anti-inflmmatory pathways?
See image attached
Hormones involved in stress response?
- Vasopressin
- Cortisol
Drugs used in refractory hypotension?
- Vasopressin
- Hydrocortisone
What is SOFA?
Sequential organ failure assessment
What organs can be affected in sepsis and how?
- Kidney - AKI
- Lungs - Respiratory failure
- CNS - Confusion
- CVS - Hypotension
- GI - Feed intolerance
- Bone marrow - Suppression
- Liver - Dysfunction , coagulation
Traditional biomarkers used in diagnosis of sepsis?
- WCC
- CRP
- Procalcitonin
What is the peak time for CRP?
Usually 3 days after primary insult
What is lactate?
- Marker of anaerobic metabolism
- Marker for organ damage
- Greater than 2mmol/L is diagnostic for sepsis
Sepsis 6 within 1 hour? Take 3 and give 3 ?
Give:
- Oxygen
- Antibiotics
- IV fluids
Take:
- Lactate
- Culture
- Urine
