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Flashcards in Sepsis Deck (19):
1

Systemic Inflammatory Response Syndrome

Massive inflammatory reaction from systemic cytokine release

2

What are the 4 components of SIRS?

– Temperature >38˚ C or 90
– Respiratory rate >20 or PaCO2 12,000 or 10% immature
– Heart rate of more than 90 beats per minute
– Abnormal white blood cell count (>12,000/µL or less than 4,000/µL or >10% immature [band] forms)

3

Sepsis Definition

SIRS plus culture documented infection

4

Severe Sepsis Definition

Sepsis plus organ dysfunction or hypoperfusion

5

Septic Shock

Refractory hypotension plus hypoperfusion abnormalities

6

What are some of the causes of SIRS?

• Bacteremia (bacterial, fungal, or parasitic infection)
• Burn injury
• Trauma or hemorrhage
• Acute pancreatitis
• Acute adrenal insufficiency
• Ischemic tissue injury

7

Is infection required for sepsis to occur?

NO

8

What are the organs most likely to fail in sepsis?

Lungs and Kidneys

9

What are the microbial structures that are connected to SIRS?

• Gram negative lipopolysaccharide

10

What are the components of LPS?

– Lipid A
– Core polysaccharide
– O-specific antigenic polysaccharide

11

What is the endotoxic part of LPS?

Lipid A

12

What are the host response mechanisms to microbe components that result in the inflammatory response?

Pattern recognition receptors – Four types: Toll-like receptors (TLRs), C-type lectin receptors, Retinoic acid inducible gene 1-like receptors (RLRs), Nucleotide-binding oligomerization domain-like receptors (NLRs)

13

What is the interaction of LPS and macrophages?

LBP-lipopolysaccharide binding protein will bind LPS and the LBP-LPS complex binds CD14 receptor TLR4 dimer on inflammatory cells - leads to the activation of genes for production of IL-1, TNF-alpha and others

14

What is the ultimate result of the activation of TLRs by microbial molecules?

NF-kB activation

15

What are the main cytokines acting in sepsis?

– TNF-alpha - central mediator with pleiotropic effects
– Interleukin-1 - endogenous pyrogen and also has pleiotropic effects

16

How is DIC caused in sepsis?

TNF-alpha will lead to the activation of the extrinsic pathway and microbial components can lead to the activation of the intrinsic pathway

17

What happens to the vasculature in sepsis and why?

Vasodilation - NO release via TNF-alpha

18

What are the 3 windows of hypo perfusion?

– Skin – cold, clammy, vasoconstriction, cyanosis
– Renal – UOP decrease below 0.5 mL/kg/hr
– Neurologic – Mental status (obtundation,
disorientation, confusion

19

What is the use of corticosteroids in septic shock?

Hydrocortisone (200 mg/day) in patients in whom hypotension persists despite adequate fluid resuscitation and vasopressor therapy

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