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Flashcards in Sepsis/ Shock Deck (21):
1

Systemic inflammatory response syndrome (SIRS)

Dysregulated inflammatory response

Presence of two or more of the following:

Temperature >38C (100.4oF) or <36C (96.8oF)

Heart rate >90 beats/min

Respiratory rate >20 breaths/min

WBC >12,000 cells/mm3, <4000 cells/mm3, or >10 percent immature (band) forms

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Systemic inflammatory response syndrome (SIRS) can arise from 

A number of different conditions 

 Vasculitis

 Burns

 Surgery

 Myocardial infarction

 Pulmonary embolus, fat or amniotic fluid embolism

 Acute pancreatitis

 Acute gastrointestinal hemorrhage

 Transfusion reactions

 Adverse drug reactions

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Sepsis =

Sepsis = SIRS + Infection

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Severe sepsis

Hypotension

Systolic blood pressure <90 mmHg

>40 mm Hg from baseline

Reversible with intravenous fluid resuscitation

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Septic shock =

Sepsis not responding to IVF resuscitation

 Requires vasopressors

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Multiorgan failure (MOF), Multiple Organ Dysfunction Syndrome (MODS)

Physiological dysfunction in ≥2 organ systems as a result of sepsis

 Respiratory

 Renal

 Coagulation

 Cardiovascular

 Bone marrow

 Hepatic

 CNS

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Multiorgan failure (MOF), Multiple Organ Dysfunction Syndrome (MODS)

 

Mortality

A image thumb
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Sepsis epi # COD 

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Increasing caues of sepsis

 Staphylococcus aureus

 Coagulase-negative staphylococci

 Enterococci

 Increasing rates of fungal sepsis

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Gram positive bacteria

Virulance factors

 Peptidoglycan

 Lipoteichoic acid

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Gram negative bacteria

virulance factors

 Lipopolysaccharide (LPS)

 Endotoxin

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What is the most powerful immune stimuli

LPS

13

Cardiovascular changes during sepsis

Vasodilatation, Low SVR

Intravascular volume depletion, hypoperfusion Tachycardia, Increased cardiac output

Eventual decreased myocardial contractility, Hypotension (sepsis -> severe sepsis)

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Pulmonary changes in sepsis

Vascular permeability

Noncardiogenic pulmonary edema

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Renal changes in sepsis

Decrease effective intravascular volume due to

systemic hypotension -> Acute tubular necrosis

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Central nervous system dysfunction during sepsis

Hypotension can lead to brain hypoperfusion.

Result of hepatic or renal dysfunction, metabolic encephalopathy

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Why is there hypotension during shock

Vasodilatation, capillary leak, hypovolemia → hypotension and poor tissue perfusion

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BACTEREMIA:

Etiology

Secondary to primary focus of infection

 Usually transient: Skin- Abscess; GU- Pyelonephritis; 

Pulmonary- Pneumonia

 

Endovascular source -> Usually sustained

 Infected intravascular device- (Catheter) Endocarditis

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BACTEREMIA complications 

 Metastatic seeding

 Vertebral osteomyelitis/diskitis

Infect foreign devices

 Septic emboli- Lung, Brain, Skin

 Endocarditis

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Risk factors endocarditis 

Structural heart disease Stenosis, sclerosis, prolapse Prosthetic valve

 Rheumatic

 IVDU

 Congenital

VSD, bicuspid AV

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Organisms related to endocarditis 

staph, viridans strep, enterococcus