sepsis Flashcards
(28 cards)
reason for more sepsis cases
- better capture
- age
- immunocomprimise
- more resistant bug
sepsis
life threatening organ dysfunction (2 or more qsofa) causes by host response to an infection
qSOFA
RR> 22
DLOC
SBP< 100
septic shock
require a pressor to maintain a MAP> 65 lactate >2
what type of infections are commonly found in RTIs?
gram + and -
what type of infections are commonly found subdiagphamatic
aerobic and gram -
what type of infections are commonly found in UTIs
gram -
what type of infections are commonly found in skin infections?
gram +
what type of infections are commonly found in RTIs?
gram + and -
what type of infections are commonly found in UTIs
gram -
what type of infections are commonly found in skin infections?
gram +
steps of the innate immune response
1- pathogen breaches skin
2- macrophages and mast cells respond to area
3- mast cells cause inflammation
2- macrophages ingest the pathogen and release cytokines
3- cytokines attract basophils/eosinophils/ more mast cells and cause local edema and increased permeability
4- cytokines cause neutrophils to stick to endothelium and invest pathogens at the site, neutrophils die to create pus
steps of adaptive immune response
1- dendritic antigen presenting cells absorb pathogen and present it on its surface
2- the APC enters lymphatic circulation to lymph nodes
3- in the lymph node, the APC attaches to help T cells where antibodies are created
4- If the pathogen itself enters lymphatic tissue, B cells will bind to them and create antibodies
5- T cells will create cytotoxic t cells which enter circulation with the antibody
6- B cell will create effector cells/antibodies
7- cytotoxic T cells and antibodies will travel to the site of infection and either neutralize or tagged them for destruction
SIRS vs Sepsis vs Severe sepsis vs Septic shock vs MODS
SIRS- fever, RR> 20, HR>90, WBC elevation,
Sepsis- 2 SIRS + infection confirmation
Severe sepsis- Sepsis + signs of hypo perfusion (no longer used)
Septic Shock- Severe sepsis refractory to appropriate fluid resuscitation
MODS- Failure of 2 or more organs
SIRS criteria
36> temp> 38 RR> 22 HR> 90 4000> WBC >12000 2 or more to qualify
qsofa
RR > 20
GCS < 14
SBP < 100
2 or more to qualify
types of gram + bacteria
MRSA
Strep
Staf
types of gram - bacteria
space bugs
Ecoli
Salomella
early goal directed therapy
SBP< 90, MAP<65 after 30ml/kg crystalloid , lactate >4
CVP 8-12»_space; give crystalloids to maintain >8
MAP >65»»epi or dope to maintain
SCVO2 > 70»»if less than 70 give PRBC to hematocrit> 30, if SCVO2 < 70 despite SCVO2 > give inotrope to SCO2 > 70
normal lactate clearance
20%/hr
SOFA criertia
Points based on deviation form normal PaO2/FiO2: 400 Plt: 150 liver, bili: 1.2 cardiovascular, MAP: 70 CNS, GCS: 15 renal, creatinine/urine output: 1.2
when are Glucocorticoids recommended in sepsis management
septic shock that is refractory to adequate fluid resuscitation and vasopressor administration
what should you consider prior to starting ABX in sepsis patients
- pt hx ( recent antibiotics received, previous organisms)
- comorbidities (DM, renal failure)
- immunocomprimise
- clinical context (eg, community- or hospital-acquired)
- suspected site of infection
- presence of invasive devices
- Gram stain data
- local prevalence and resistance patterns
ABX therapy in sepsis
Coverage should be directed against both gram-positive and gram-negative bacteria and, if indicated, against fungi (eg, Candida) and rarely viruses (eg, influenza)
