Week 7 , Lecture C - Sepsis Flashcards
What is SIRS
Clinical response arising from
nonspecific insult, including
2 or more of the following:
• Temperature =/>38oC or 90 beats/min • Respirations =/>20/min • WBC count =/> 12,000/mm3 or 4,000/mm3 or less than or >10% immature neutrophils
What is sepsis
SIRS with a presumed
or confirmed
infectious process
What is severe sepsis?
Sepsis with 1 or more sign of organ failure Cardiovascular (refractory hypotension) Renal Respiratory Hepatic Hematologic CNS Metabolic acidosis
Incidence and mortality for septic shock
Rare but death rate is 50%
Where can patients with sepsis come from?
Community and be admitted to ward or icu
or
may develop it while in hospital or ICU, especially if develops pneumonia
What is the management of septic shock?
Early recognition Early haemodynamic resuscitation and continued support Early and adequate antibiotic therapy Source control Tight glycaemic control Protective mechanical ventilation
Effect of infection on muscles
pro-inflammatory cytokines > intracellular mediators > catabolism or dysfunction > breaking down of muscle mass
Effect of immobilsation on muscles
Muscles - not inactive partners during immobility - work in bidirectional role to inflammatory signalling Proinflammatory state develops with bed rest, with production of reactive oxygen species (ROS), and ¯ in antioxidative defences Immobile muscles therefore cause even more acute as well as long term deleterious effects to patient.
Why exercising ICU patient is good for their muscles
Exercise training - been shown to ¯ the local expression of
cytokines & inducible nitric oxide synthase (iNOS)
in muscle biopsies of CHF patients
Barriers to exercise in early stage septic shock
Cardiovascular instability High vasopressor requirement Vasodilatation ie vasoplegic Respiratory instability Nitric oxide Invasive lines ++ Heavy sedation Equipment ++
preliminary evidence early stage septic shock
Passive stretch = increased cognititon, decreased delirium, decreased length of stay
How can physio affect the prognosis of someone with sepsis
We can make a difference in weakness post ICU in sepsis by: Early passive exercise EMA Sitting on edge of bed Sitting up high Active assisted X’s as soon as able Early walking with equipment