05-06 Sepsis (Ch 27) Flashcards Preview

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Flashcards in 05-06 Sepsis (Ch 27) Deck (12):
1

What is sepsis?

infection + SIRS

2

Definition & Causes of SIRS

Definition of SIRS (Systemic Inflammatory Response Syndrome)


  • 2+ disturbances of temp, HR, RR/PaO2, or WBC
     

Causes

  • #1 = INFECTION
  • Endogenous organ damage (pancreatitis)
  • Immune system freak-out (lupus)
  • Trauma
  • Misc (thyroid storm, e.g.)

3

What is septic shock?

sepsis + SBP < 60mmHg

4

REVIEW the epidemiology of sepsis

Not that uncommon, hits fast and hard, can kill even young and healthy people

  • Treatments have not improved much reccently

5

DESCRIBE the predominant causes of sepsis

  • Classes of organisms
  • Infectious syndromes/diseases

Organisms

  • Most sepsis is caused by bacteria
  • Some by yeast & fungi
  • Not really by viruses

Diseases

  • #1 is pneumonia (36%)
  • #2 is 1° bloodstream infx, e.g. endocarditis (20%)
  • #3 is intra-abd (19%)
  • #4 is UTI (13%)
  • #5 is skin/soft tissue (7%)
  • rest "other"

6

Pathophysiology of sepsis

  • Four immunologic responses that become maladaptive


Four immunologic responses that become maladaptive
 

  1. BVs dilate
    • INTENT: improve tissue perfusion
    • RESULT: low BP
  2. BVs leaky
    • INTENT: improve WBC diapedesis
    • RESULT: low BP
  3. Cytokine chorus
    • INTENT: recruit help
    • RESULT: runaway imm resp
  4. Sympathetic storm
    • INTENT: route blood to critical areas
    • RESULT: ischemia in "non-crit" areas

Maladaptive Coagulation

  • Causes DIC (disseminated intravascular coagulation)

Superimposed Tissue Injury --> Further inflamm freak-out

Organ Damage

  • Examples: renal failure, digital necrosis, AMS, abnl LFTs etc.

Cause of Death = multi-organ system failure

7

REVIEW the clinical manifestations of sepsis

  • hypotension
  • tachy
  • temp

8

REVIEW the diagnosis of sepsis

.

9

DESCRIBE the role of body fluid cultures in the systematic work-up of sepsis

If you can't find the source of infection, culture everything:

  • urine to r/o UTI
  • sputum to r/o pneumonia
  • CSF to r/o meningitis
  • blood to r/o bacteremia

10

DESCRIBE the role of imaging in the evaluation of patients with sepsis

DESCRIBE the role of common imaging modalities in the systematic work-up of sepsis

Check for source of unknown infection using CT (e.g. liver abscess, pleural empyema, etc.) and MRI (e.g. to r/o necrotizing fasciitis)

11

REVIEW the treatment of sepsis

DESCRIBE the antibiotic and other treatments of sepsis

Treat quickly!

Start w/ antibiotics: tx for the known infection (which is likely the cause of sepsis)

  • If source of infx is not obvious hunt for it quickly (empyema w/ that pneumonia? CT it! MRI leg maybe there's necrotizing fasicitis, etc.)

 Maintain hemodynamic stability

  • IV fluids (crystalloids; little evidence to support giving blood or colloids)
  • pressors (NE or vasopressin)

Good ICU Care

  • maintain tight glucose control
  • ventilate, PRN
  • hemodialysis, PRN
  • prevent harm: DVTs, contractures, line infxs, psychosis, etc.

Consider adjuvant steroids and activated protein C

12

REVIEW the role of drainage of pus in the management of sepsis

If you find collections of pus, e.g. empyema, you need to drain in addition to abx Rx