Please enable JavaScript.
Coggle requires JavaScript to display documents.
Micro - Overview of Sepsis (i) (Sepsis (aberrant/disregulated host…
Micro - Overview of Sepsis (i)
Infection
presents in different ways
non-specific symptoms
pyrexia
sweats
rigors
anorexia
fatigue
myalgia
arthralgia
symptoms related to infection site
resp (dyspnoea, cough, sputum)
UTI (polyuria, dysuria, flank pain)
skin (erythema, pain)
meningitis (headache, neck stiffness)
abdomen (pain, distension)
SIRS
clinical response to non-specific insult
abnormal vital signs
temp > 38 or < 36
tachycardia
tachypnoea
WCC > 12 or < 4 (leukocytosis or leukopenia)
blood glucose > 7.7 mmol/L in a non-diabetic
altered mental status
cause can be infectious or non-infectious
doesn't have to be microbiologically confirmed in lab
pathological process caused by invasion of normally sterile tissue / fluid / body cavity by pathogens
Sepsis
host response to infection, leading to organ dysfunction
ALWAYS SECONDARY TO INFECTION
i.e. not everyone with an infection gets sepsis by everyone with sepsis has an infection
clinical Dx
symptoms of organ dysfunction
acute confusion (brain)
tachypnoea, hypoxia (lung)
tachycardia, systolic hypotension (heart)
oliguria, increased creatinine (poor clearance, kidney dysfunction)
prolonged central capillaries refill, purpuric rash (bleeding into mucosa + submucosa) (skin)
no lab test
aberrant/disregulated host response
hyperreactivity (imbalanced)
CKs
inflamm
SIRS
DIC
microvasc thrombosis
fibrinolysis
complement
primary cause of death from infection
death from body's response rather than pathogen itself
must be recognised + Tx quickly
inadequate recognition = most common reason for poor outcome
time dependent medical emergency
mortality increased by 7.6% per hr of antibiotic delay
syndrome shaped by
pathogen factors
virulence
inoculation dose
drug resistance
host factors
gender
genetics (some polymorphisms increase susceptibility)
extremes of age
comorbidities (esp DM)
general health status
immunomodulatory medication
2 interventions
resuscitation via sepsis 6 in 1st hour
referral to critical care or for a more senior review
patients should be educated to recognise symptoms
Septic shock
sepsis causing dangerous hypotension
contact consultant + critical care
Septicaemia
when a BSI causes sepsis
Systemic effects of Sepsis
tissue ischaemia
microcirculatory + endothelial lesions
cytopathic injury
direct injury via CKs
CKs delay apoptosis
immunosuppression
widespread cellular injury (precursor to organ dysfunction
Organ specific effects of sepsis
circulatory
vasodilation
increased vasc permeability
hypotension
hypoperfusion
lung
endothelial injury
disturbed capillaries blood flow
VQ mismatch (hypoxia)
increased microvasc permeability
pul oedema
GIT
normal barrier function depressed due to circulatory abnomalities - bacterial translocation
Liver RES
decreased bacterial clearance
normally 1st line of defence against bacteria entering the portal system via the gut
Kidney
acute renal failure
tubular necrosis
hypoperfusion
systemic hypotension
renal vasoconstriction
ck release
NS
encephalopathy
BBB dysfunction
leukocyte, toxin + CK infiltration