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Sepsis - Coggle Diagram
Sepsis
Pathophysiology
Vasodilation
Endothelial NO production
Distributive shock
reduced oxygen delivery
Decreased endothelial integrity
tight junctions
Bacterial translocation
interstitial oedema
Reduced myocardial contractility
Activation of coagulation cascade
Diffuse endothelial injury
microthrombi
Mitochondrial dysfunction
Increased Sv02
high lacate
Sepsis 3 definition
life threatening organ dysfunction
Dysregulated host immune respone
to infection
septic shock
vasopressor requirement
lactate >2
Trials
EGDT
Rivers
Early goal directed herapy
CVP 8-12
MAP >65
Target haematocrit >0.3
If Scv<70% add dobutamine
Continuous Scv02 measurement
Negative
PROCESS
ARISE
PROMISE
MAP 65
SEPSISPAM
Vasoactives
VASST
Vasopressin
VANISH
<RRT with vasopressin
LeoPARDS
Levosimendin
Steriods
CORTICUS
hydrocortisone
Negative trials
HYPRESS
ADRENAL
Fludrocortisone +HYdrocortisone
Management
Take 3
Blood cultures
Lactate
UO
Give 3
Antibiotics
30mls/kg bolus
Catheter
At 6 hours
Vasopressors
Repeat lactate
Any two of
CVP
Scv02
Bedside echo
Straight leg raise