septicemia Flashcards
TERMS
- SEPTICEMIA- presence of pathogens and toxins in blood
- BACTEREMIA- presence of bacteria and toxins in the blood
- SEPSIS- whole body inflammation caused by infection
SIRS
- systemic inflammatory response syndrome (SIRS)
- a systemic inflammatory response
- typically an immune response to infection but not always
SIRS CRITERIA (ANY TWO OR MORE)
- TEMP ( >100.4 OR <95.0) (>38 OR <36)
- RR (>20 OR PaCO2 < 32)
- HR (>90/MIN)
- WBC ( >12,000 OR <4,000)
SIRS STAGES
- SEPSIS
- SIRS with a microbial source - SEVERE SEPSIS
- sepsis with >one organ system dysfunction (hypotension, AMS, Acidosis, oliguria, ARDS) - SEPTIC SHOCK
- severe sepsis with hypotension unresponsive to fluid resuscitation - MODS
- > one organ system requiring interventional homeostasis
MEWS AND PEWS
- modified early warning system
- pediatric early warning signs
- like SIRS criteria but may include more/fewer signs
WHAT IS SEPSIS
- sepsis is the result of an infection
- the infection is uncontrolled or spreads and releases bacteria or toxins into the blood
- this triggers the systemic inflammatory response
- sepsis is SIRS caused by an infection
SEPSIS PROCESS
-when the inflammatory response becomes exaggerated, inflammation and coagulation increase
- leads to microthrombi, and obstruction of capillaries
(tissue isn’t perfusing ) - endothelial (vein/arterial) damage, vasodilation, increased capillary permeability
SEVERE SEPSIS
- if sepsis is not controlled it enters what we call severe sepsis
- this is sepsis with one organ system damaged or experiencing failure
- BP decreases , poor organ perfusion
DISSEMINATED INTRAVASCUALR COAGULATION
DIC- widespread activation of clotting which causes clots in small blood vessels
- leads to a drop in tissue perfusion which can lead to tissue and organ damage or failure
- sepsis in one of the causes
TREATMENT OF DIC
- monitor vital signs, clotting factors
- assess for signs of hemorrhage, bleeding
- fix hypovolemia (give fluid)
- possibly platelet transfusion
- possibly heparin, especially prophylactically when DIC is slowly evolving, not when it is quick
WHAT IS SHOCK
- generally , it is when there is sufficient blood flow to meet the body’s demands (lack of perfusion )
- several types
1. cardiogenic
2. hypovolemic
3. anaphylactic
4. neurogenic
5. septic
SEPTIC SHOCK
this is severe sepsis with persistent hypotension which is unresponsive to fluid replacement therapy and organ system damage and /or failure to 2 or more organ systems . (MODS) multiple organ dysfunction syndrome
- very high mortality rate
- organ systems become damaged as a result of decreased tissue perfusion
- hypotension
- microvascular occlusion (DIC)
STAGE 1: COMPENSATORY SHOCK
- baroreceptors detect drop in MAP
- SNS kicks in, ups HR, and cardiac contraction
- peripheral vasoconstriction
- perfusion of systems is maintained due to this
- signs are nearly imperceptible
STAGE 2: PROGRESSIVE SHOCK
- sustained drop in BP
- compensatory mechanisms from stage 1 are still active , but unable to keep MAP up
- vasoconstriction actually starts to limit blood flow
- lactic acid builds up causing acidosis
- Sodium- potassium pump of cels fails, leads to loss of intracellular K, Na and water move in
- cells swell up from Na and water, causes organelle damage
STAGE 3: REFRACTORY SHOCK
- tissue damage and lack of oxygen become so widespread that tissues and organ s fail and die
- even if MAP is restored, damage has become too widespread to prevent organ death
SEPTICEMIA EARLY SIGNS
- hypotension
- rapid, thread pulse
- quick, deep respirations
- warm flushed skin
- alert and oriented x 3
- normal urine output (>30 ml/hr)
- elevated temp
SEPTICEMIA LATE SIGNS
- hypotension
- tachycardia, possibly arrhythmias
- rapid, shallow respirations, dyspnea
- cool, pale, edematous
- lethargic, possible comatose
- oliguria, or anuria
- decreased temperature
ASSESSMENT
SEPSIS
-acidotic, cool pale, low BP, low MAP
SEPTIC SHOCK
- low urine output, arrhythmias, LOC decreased, low K, increased NA and water in cells
DIAGNOSTIC LABS
- WBC
- electrolyte
- PH
- lactic acid
- CO2
- ABG
INITIAL TREATMENT
- will be early goal directed resuscitation therapy
- fluid challenge of 30 ml /kg of crystalloid solution (NS, D5 1/2, lactated ringers ) isotonic
- vasopressors - vasopressin, dopamine, norepinephrine
- goal is to raise MAP , heart rate, urine output >0.5 ml/kg/hr
ALBUMIN
the idea is that albumin acts as an anti-inflammatory and anti-oxidant and helps maintain plasma osmolarity
-however the benefits compared to only administering crystalloid IV fluids are virtually no existent and there is a risk of complications when administering albumin
IF EDGT UNSUCCESSFUL
- admittance to ICU likely
- antibiotics to treat infection
- resuscitation via oxygen, maintain airway, possible mechanical ventilation in shock
- RBC/ platelet transfusion
- external cooling or heating
- nutritional support, shock pts, generally lack sufficient protein
- vasopressin for hypertension
- monitor lactate levels- normal is (0.5-2.0)
lactate is a product of cellular metabolism that can accumulate when cells lack O2
