Septic shock Flashcards
Sepsis
The presence of infection in association with ……………. (SIRS).
The presence of SIRS is not limited to sepsis however the presence of infection and an increase in the number of SIRS criteria is an indication of possible ……. ………….. and developing organ ………………
Sepsis
The presence of infection in association with Systemic Inflammatory Response Syndrome (SIRS).
The presence of SIRS is not limited to sepsis however the presence of infection and an increase in the number of SIRS criteria is an indication of possible endothelial dysfunction and developing organ dysfunction.
Systemic Inflammatory Response Syndrome.
- SIRS term developed in the attempt to describe the clinical manifestations resulting from systemic responses to infection.
- Temperature >…… or ……….
- Heart rate >…….beats per minute.
- Respiratory rate >……. breaths per minute or arterial CO2 lower than ……. mmHg.
- White blood cell count >………../µl or
Systemic Inflammatory Response Syndrome.
- SIRS term developed in the attempt to describe the clinical manifestations resulting from systemic responses to infection.
- Temperature >38OC or <36OC.
- Heart rate >90 beats per minute.
- Respiratory rate >20 breaths per minute or arterial CO2 lower than 32 mmHg.
- White blood cell count >12,000/µl or <4000/µl
Severe Sepsis
- Sepsis complicated by end-organ dysfunction, this can be signalled by:
- Alteration in …….. ……
- …………
- E……… ……….. ………ate levels
- O………..
Severe Sepsis
- Sepsis complicated by end-organ dysfunction, this can be signalled by:
- Alteration in mental state
- Hypoxemia
- Elevated plasma lactate levels
- Oliguria
Septic Shock
- A state of ……….. circulatory ……… characterised by persistent ………. hy………. despite …………. fluid res………….. or by tissue hypo…………
- Manifested by a lactate concentration > …mg/dL.
- Unexplained by other causes.
Septic Shock
- A state of acute circulatory failure characterised by persistent arterial hypotension despite adequate fluid resuscitation or by tissue hypoperfusion.
- Manifested by a lactate concentration > 4mg/dL.
- Unexplained by other causes.
Septic shock remains one of the leading causes of death in hospitalised patients.
Barely …..% of patients suffering from severe sepsis survive their hospital admission.
………,897 general surgery patients.
…,350 patients suffered from sepsis.
…,977 patients suffered from septic shock or life threatening low blood pressure.
Death rates within 30 days from sepsis were ….4%.
Death rates within 30 days from septic shock were ….3.7%.
Septic shock remains one of the leading causes of death in hospitalised patients.
Barely 50% of patients suffering from severe sepsis survive their hospital admission.
363,897 general surgery patients.
8,350 patients suffered from sepsis.
5,977 patients suffered from septic shock or life threatening low blood pressure.
Death rates within 30 days from sepsis were 5.4%.
Death rates within 30 days from septic shock were 33.7%.
Pathogenesis of Shock
- Inf……… or Non inf…………. triggers
- …………. and ……………. mediator cascade
- Cardiac Dysfunction and ……………r Injury
- …………….. and ……………
Pathogenesis of Shock
- Infectious or Non infectious triggers
- Cytokine and inflammatory mediator cascade
- Cardiac Dysfunction and Microvascular Injury
- hypotension and shock
Risk Factors
Extremes of age (…. years).
Primary disease:
- Diabetes ………
- Solid …………..
- …………….. diseases
Immunosuppression:
- N……………
- I…………………… therapy
Major surgery, trauma and burns.
Invasive procedures:
- ………………..
- ……………….. devices.
Previous ……………. therapy.
Prolonged …………………
Risk Factors
Risk Factors
Extremes of age (<10 years and >70 years).
Primary disease:
- Diabetes melltius
- Solid Malignancy
- Cardiopulmonary diseases
Immunosuppression:
- Neutropenia
- Immunosuppressive therapy
Major surgery, trauma and burns.
Invasive procedures:
- Catheters
- Intravascular devices.
Previous antibiotic therapy.
Prolonged hospitalisation.
Characteristics of Septic Shock
Systemic vasodilation and hypotension.
Tachycardia:
- Depressed contractility.
Vascular leakage and edema:
- …………….
Compromised ………….. …………..flow to organs.
Di………….. int………… coa……….
Abnormal blood gasses and …………..
Respiratory …………….. and m……………… ……….. failure.
Characteristics of Septic Shock
Systemic vasodilation and hypotension.
Tachycardia:
- Depressed contractility.
Vascular leakage and edema:
- Hypovolemia
Compromised nutrient blood flow to organs.
Disseminated intravascular coagulation.
Abnormal blood gasses and acidosis.
Respiratory distress and multiple organ failure.
Microbial Mediators/Triggers Gram negative bacteria: - Lipopo................... Klebsiella ......................... – .......... Escherichia ......... – ........., ......., .... Ha................. sp – L............. Pse.............. sp – ......., ....... Pro......... sp – ........... Sal............. sp - ..........
Microbial Mediators/Triggers Gram negative bacteria: Lipopolysaccharide. Klebsiella pneumoniae – LRTI Escherichia coli – LRTI, UTI, GI Haemophilus sp – LRTI Pseudomonas sp – UTI, GI Proteus sp – UTI Salmonella sp - GI
Gram positive bacteria:
Li…………… acid
Cell wall mu………. p…………..
Sta………………… au…………. – …….., ………Tissue Infection.
Strep………….. on…………… – LRTI
Stre……………..i sp – ……….. Tissue Infections, GUM
Superantigens:
Staph……………… Toxic ………….. Syndrome Toxin (TSST).
Strep…………… Pyr………….. Ex…………… (SPE).
Gram positive bacteria:
Lipoteichoic acid
Cell wall muramyl peptides.
Staphylococcus aureus – LRTI, Soft Tissue Infection.
Streptococcus pneumoniae – LRTI
Streptococci sp – Soft Tissue Infections, GUM
Superantigens:
Staphylococcal Toxic Shock Syndrome Toxin (TSST).
Streptococcal Pyrogenic Exotoxin (SPE).
Cytokine mediators
Systemic ,,,,,,,,,,,,,,,,, activation by microbes
Systemic ,,,,,,,,,,,,,,,,, 1 and ,,,,,,,,,,,,, necrosis factors alpha
…………………./……….. molecular activation
secondary mediators (N.., P….., P.., L..)
V……………., ………….. leak, ………………… damage
Sh……… > M……… > death
Cytokine mediators
Systemic macrophage activation by microbes
Systemic Interleukin 1 and tumour necrosis factors alpha
Endothelial/laukocyte molecular activation
secondary mediators (NO, PAF, PG, LT)
Vasodilation, capillary leak, endothelial damage
Shock > Mods > death
Actions of Leukotrienes
Br……………….
Ch……………….
Leu………….. – Endothelial cell adhesion
Le………………. emigration
V………………… leakage
Stimulate le…………… and oxygen free r…………… release.
Actions of Leukotrienes Bronchoconstriction Chemotaxis Leukocyte – Endothelial cell adhesion Leukocyte emigration Vascular leakage Stimulate leukotriene and oxygen free radical release.
Actions of Platelet Activating Factor
Va………………………../Va………………..
Hy………………. and ………………….. depression
B……………………………
C……………………..
L……………… – Endothelial cell ……………….
Le…………….. e………………….
Va…………….. lea………………
Pl……………… ag………………….
Stimulate le………………., …………, c……………..and oxygen-free ………….. release.
Actions of Platelet Activating Factor
Vasoconstriction/Vasodilation Hypotension and cardiac depression Bronchoconstriction Chemotaxis Leukocyte – Endothelial cell adhesion Leukocyte emigration Vascular leakage Platelet aggregation Stimulate leukotriene, PAF, cytokine and oxygen free radical release.
Pathophysiology of Septic Shock
General Signs and Symptoms: .................... ..... symptoms ............ ................ General ................ L....................
T………………. and hy………………..
H…………………….
Fo……………. of infection may not be evident.
Pathophysiology of Septic Shock
General Signs and Symptoms: Flu like symptoms Fever Chills General malaise Lethargy Tachycardia and hypotension Hyperventilation Focus of infection may not be evident.
Pathophysiology of Septic Shock
Cardiovascular complications:
S…………. v……………………
H…………………..
Tachycardia (>………………… beats/min)
Increased …………… output, however c…………… is depressed.
Decrease in central v…………… pressure (could be an increase depending on fluid resuscitation).
Hy……………… due to v………… leakage.
Pathophysiology of Septic Shock Cardiovascular complications: Systemic vasodilation Hypotension Tachycardia (>100 beats/min) Increased cardiac output, however contractility is depressed. Decrease in central venous pressure (could be an increase depending on fluid resuscitation). Hypovolemia due to vascular leakage.
