Sepsis Flashcards
(35 cards)
Most common causes of sepsis
Gram positive
Methicillin resistant staphylococcus
Enterococcus
Fungi has risen in immunosuppressed
Most common locations for sepsis infections
Pneumonia, intra-abdominal, urinary, skin/soft tissue
General definition
Suspected or confirmed infection with evidence of systemic inflammation (demonstrated through evidence of immune response or lab results)
Definition for severe sepsis
Sepsis plus evidence of new organ dysfunction thought to be secondary to tissue hypoperfusion
Septic shock definition
Cardiovascular failure occurs, with infection, evidenced as persistent hypotension or need for pressures despite adequate pressors
Mortality rates of infectious and non infectious sepsis
3% without SIRS
6% meeting two SIRS criteria
17% for those meeting all four
Serum lactate
Excellent prognostic data in sepsis.
From tissue hypoperfusion.
28 day mortality rate of 15% with lactate 2-4mmol/L
SIRS criteria
Temp <38.3 >36.0
Pulse rate >90min or 2 SD above normal for age
Tachypnea >20
Leukocytosis (WBC > 12,000 cells/uL) or leukopenia <4000 cells/uL, or normal WBC with 10% immature forms
Sepsis signs
Fever, hypothermia Tachycardia Tachypnea Altered LOC Edema Hyperglycemia C-reactive protein Hypotension (systolic <90, MAP <70) Acute oliguria INR >1.5 or PTT >60s Thrombycytopenia (too low) Elevated creatinine, bilirubin Low platelets
ED pts with undifferentiated hypotension
40% from infectious
ARDS
New lung edema from increased alveolar and cap permeability
Pulmonary injury
Doesn’t need pneumonia in sepsis, still can have ARDS.
Classification of ARDS
Mild - PaO2/FiO2 of 200-300
Moderate 100-200
Severe <100
27% mortality in mild, 45% on severe
Renal injury
Injury from hypoperfusion is a major factor, but also toxic products from neutrophil-endothelial interactions, and DIC
Ileus
Lack of movement somewhere in intestines
SIRS
Criteria does not confirm presence of infection or sepsis, it is simply a crude stratifcation of patients with systemic inflammation
Hepatic injuries in sepsis
Infrequent but most likely cholestatic jaundice
Red blood cell hemolysis from microvascular coagulation can also rarely cause jaundice
GI changes in sepsis
Ileus is most common, which may persist for days after shock resolves
Major blood loss is rare, but minor blood loss within 24 hours from painless eroisions of in the mucosal layer of stomach or duodenum are possible
Cytosis/penia
Cytosis is too many, penia too few
Piss in sepsis
Azotemia, oliguria, anuria
Azotemia
High levels of nitrogen in urine
Hematologic changes in sepsis
Neutropenia, Neutrophilia, thrombocytopenia, or DIC is all possible.
Neutropenia is rare but increases mortality rates
Red cell production is suppressed but anemia is unlikely unless it pre exists or the infection is extremely prolonged
Thrombocytopenia possible due to DIC, presents in <30%
If DIC happens, very poor prognosis
Metabolic changes in sepsis
Lactate from tissue hypoperfusion
Hyperglycemia regardless of diabetes (bad prognosis if no beeties)
Hypoglycemia possible
Adrenal insufficiency from hypoperfusion, adrenal or pituitary hemorrhage, cytokine dysfunction, drug-induced hypermetabolism, inhibition of steroidogenesis and desensitization of glucocorticoid reponsiveness
Skin (5 potential manifestations)
Direct bacterial (cellulitis, erysipelas, fasciitis)
Lesions from hematogenous seeding of skin (petechia, pustules, cellultis, ecythma gangrenosum)
Lesions from hypotension/ DIC (acrosyanosis, necrosis of peripheral tissue)
Lesions from intravascular infections (microemboli/ immuno complex vasculitis)
Lesions from toxic shock
