Multiorgan Failure Flashcards
Bacteraemia
Presence of viable bacteria in the blood stream
Will have a transient bacteraemia after brushing your teeth
Sepsis
Two or more signs of a systemic inflammatory response with evidence of infection
Severe Sepsis
Sepsis with organ dysfunction
Septic Shock
Sepsis with hypotension requiring inotropes
Systemic inflammatory response
Temp –> >38C or >90 beats per min
Resp Rate –> >20 breaths per min or PaCO2 12,000 cell/mm3
Multiple organ failure
Systemic inflammatory response PLUS:
Acute lung injury or ARDs
Encephalopathy
Hypotension unresponsive to fluids +- inotropes
DIC with INR >1.3 or platelets 2mmol/L) or metabolic acidosis
Oligouria or abnormal liver function +-GI dysfunction
Treatment of Multi-organ failure
Supportive –> culture then drain infection/abx
Oxygen +- ventilation –> fluid resuscitation/vasopressors
Haemofiltration and Nutritional support
Prevent the development of further complications
Gut directed therapy
Use fluid resuscitation and monitor splanchnic perfusion
May use Sucralfate and splanchnic vasodilators
Consider maintaining enteral nutrition
Selective decontamination of the digestive tract
Enteral nutrition
Pros –> Physiological, cheap, protects gut integrity and increases blood flow
Cons –> aspiration, bowel dilation, diarrhoea and constipation
Parenteral nutrition
Pros –> Calorifically complete, less risk of mal-absorption, may be lifesaving,
Cons –> Requires central line, expensive, mucosal atrophy, immunosuppressive
Prevention of sepsis
Have a low threshold for calling for help
Careful monitoring of high risk patients
Early detection of deterioration
Timely intervention with fluids, antibiotics, oxygen
Signs of developing sepsis
Systolic BP 25/min
HR 110/min or O2 sats 40% FiO2
Urine <100ml in 4hrs or Drop in GCS
