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Sepsis (Clinical manifestation (Systemic inflammatory response syndrome…
Sepsis
Clinical manifestation
- Sepsis is defined as systemic inflammatory response syndrome (SIRS) resulting from infection (bacterial, viral, fungal, or parasitic).
- The increasing severity and mortality of sepsis is illustrated by a continuum of events: Severe sepsis, Septic shock, Multiple organ dysfunction syndrome (MODS), which often results in death
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- Sepsis
Sepsis is defined as SIRS resulting from infection (bacterial, viral, fungal, or parasitic)
- Severe sepsis
Severe sepsis is sepsis associated with at least one acute organ dysfunction, hypoperfusion, or hypotension
- Septic shock
Septic shock occurs when sepsis-induced hypotension persists despite adequate fluid resuscitation.
- Multiple organ dysfunction syndrome (MODS)
MODS is characterized by the presence of altered function of two or more organs in an acutely ill patient, such that homeostasis cannot be maintained without intervention
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Symptoms of sepsis
- hyperthermia; often with chills, headache
- myalgia and arthralgia, abdominal pain; mausea
- lost of consciousness, pallor; purpura fulminans
- tachycardia; hipotonia
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- Sources of sepsis:
Respiratory 38%, Urinary tract 21%
Intra-abdominal 16.5%, CRBSI 2.3%
Device 1.3%, CNS 0.8%
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- Systemic Inflammatory Response Syndrome:
A clinical response arising from a nonspecific insult, including ≥ 2 of the following:
Temperature ≥38oC or ≤36oC
HR ≥90 beats/min
Respirations ≥20/min
WBC count ≥12,000/mm3 or
≤4,000/mm3 or >10% immature neutrophils
- Sepsis: SIRS with a presumed or confirmed infectious process
- Severe Sepsis:
Sepsis with ≥1 sign of organ failure
Cardiovascular (refractory hypotension), Renal, Respiratory, Hepatic, Hematologic, CNS, Metabolic acidosis
- Sepsis: Systemic inflammatory response to known or suspected infection
- Severe Sepsis: SIRS associated with organ dysfunction (failure), hypoperfusion, and perfusion abnormalities
- Septic shock:
A subset of severe sepsis, where patients experience combined decreased systemic vascular resistance and the presence of reduced myocardial performance
- Septic shock is bundled with non-related diagnoses for non-traumatic shock including:
-Extracardiac obstructive shock:
Pericardial tamponade, Constrictive pericarditis, Pulmonary embolism
-Oligemic shock
Dehydration, Hemorrhage
- Patients at risk of developing severe sepsis:
All critically ill patients
Severe CAP (community-acquired pneumonia)
Intra-abdominal surgery, Meningitis
Chronic diseases (including diabetes, heart failure, chronic renal
failure, and COPD)
Compromised immune status (HIV/AIDS, use of cytotoxic and immunosuppressive agents, malignant neoplasms, and alcoholism)
Cellulitis, Urinary tract infection
- SIRS expanded to signs and symptoms
Chills, Alteration in temperature, Tachypnea
Change in mental status, Tachycardia
Altered WBC, Bandemia, Thrombocytopenia
Decreased perfusion: mottling, poor capillary refill
Increased blood sugar, Petichiae/Purpura
Clinical picture of sepsis (laboratory investigations and diagnosis)
SIRS - at least two of following:
Leucocytes >12000/mm3 or <4000/mm3 or >10% immature band forms
Temperature >38°C or <36°C
HR >90bpm
Respiration >20bpm
Severe sepsis: above + at least 1 sign of organ failure
MODS: above + at least 2 signs of organ failure
Shock: hypotension SBP<90mmHg