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Flashcards in Septicemia Deck (13):
1

SIRS definition

The presence of 2 or more of the following:

Temp: >38.5 or 90 bpm
RR: >20 breaths/min
PaCO2 <32
WBC: 12 000 or 10% bands

2

Sepsis definition

SIRS+ known infection

3

Severe sepsis

SIRS+ known infection + organ dysfunction

4

Septic shock

SIRS+ known infection+ organ dysfunction+ hypotension despite adequate fluids (require vasopressor support)

5

Refractory septic shock

Septic shock + lots of dopamine/epi/NE

6

Sepsis
-epidemiology (incidence of sepsis in last century and who is likely to get it)

-incidence of sepsis has gone up because all of the following list has gone up, and resistance has too.

At risk:
-invasive medical devices (e.g. intravascular catheters)
- immunosuppressed cancer and transplant patients
-Diabetes

7

Sepsis
-clinical presentation
-what to look for on the physical

Usually non-specific:
-fever
-chills
-fatigue, malaise, anxiety, confusion

What to look for:
-focal symptoms that may tell you where the infection started
-neck stiffness (as in meningitis)
-purpura fulminans (sign of DIC)

8

Sepsis
-what tests to order

-blood/urine/sputum/tissue cultures +Gram stain
-CBC with differential
-Serum electrolytes, glucose
-Renal function (creatinine, BUN)
-Liver function (AAT, ALT, bilirubin)
-Lactate (tells you if hypoperfusion exists)
-Arterial blood gases
-Prothrombin time (DIC?)
-CXR if suspected pulmonary
-US if suspected biliary
-CT if suspected intraabdominal

9

Sepsis
-management

-Must achieve control of the infection source
-Start broad spectrum empiric therapy as soon as the cultures are drawn. Therapy is based on the suspected source of infection.
**v. important to start broad-spectrum therapy ASAP***
-Hemodynamic support (IV fluids, vasopressors

10

When to do a blood culture

-endocarditis
-pyelonephritis
-pneumonia
-meningitis
-pyogenic (septic) arthritis
-osteomyelitis
-PID
-cellulitis
-ill children and ill elderly with serious nondescript S/S

11

Common causes of immunocompromise

-Genetic
-Acquired (HIV, some cancers)
-Chronic (DM, cirrhosis)
-Medications (steroid, chemotherapy, radiation, transplant meds)
-Pregnancy

12

Possible affected immune system components

Damaged integuement
Impaired cellular immunity
Impaired humoral immunity
Asplenia
Complement deficiency
Neutropenia

**each deficiency will have a different set of pathogens**

13

Febrile neutropenia
-definition
-epidemiology (who gets it)
- management

- Fever and ANC < 500 (normal 2500-6000)
-Often cancer patients undergoing chemotherapy get this
-Start empiric Ab right away: Pip-tazo if no focus of infection is known
-So many flow charts....