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Sepsis

Sepsis. Douglas Stahura D.O. Grandview Hospital March 21, 2001. Definitions. Infection – microbial phenomenon characterized by inflammatory response to the presence of micro-organisms or the invasion of normally sterile host tissue Bacteremia – presence of viable bacteria in the blood.

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Sepsis

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  1. Sepsis Douglas Stahura D.O. Grandview Hospital March 21, 2001

  2. Definitions • Infection – microbial phenomenon characterized by inflammatory response to the presence of micro-organisms or the invasion of normally sterile host tissue • Bacteremia – presence of viable bacteria in the blood

  3. Definitions • SIRS – Systemic inflammatory response to a variety of severe clinical insults, including infection, pancreatitis, ischemia, multiple trauma and tissue injury, hemorrhagic shock, immune-mediated organ injury, and exogenous administration of inflammatory mediators such as tumor necrosis factor and other cytokines

  4. Definitions • Sepsis – Systemic response to infection. This response is identical to SIRS, except that it must result from infection

  5. Definitions • Septic shock – Sepsis with hypotension (SBP<90 mm Hg or a reduction of 40mm Hg from baseline) despite adequate fluid resuscitation, in conjunction with organ dysfunction and perfusion abnormalities

  6. SIRS Criteria • 2 or more must be present • Temp >38 or < 36 • Heart Rate >90 bpm • Resp Rate > 20 bpm or PaCO2 < 32 mm Hg • WBC’s >12,000 or < 4,000 or > 10% bands

  7. Clinical Considerations • Diagnosis of sepsis considered when patient meets numerical criteria for SIRS • Thorough H+P may reveal clues to the source of sepsis • Sepsis caused by GN organisms is hemodynamically indistinguishable from sepsis caused by GP organisms

  8. Clinical Considerations • Multiple cultures from multiple sites • Blood Cultures • Drawn from two different sites • Set= aerobic and anaerobic bottle • Each bottles requires 7-10 ml • Candida • Isolation from sputum, urine, stool is not necessarily synonymous with infection • Isolation from blood always significant

  9. Clinical Considerations • Antibiotics are the cornerstone of tx • Supportive care is essential • Fluids • Pressors • Ventilation • Nutrition • Monitoring – PA line, Lytes

  10. Summary • Appreciate the mortality associated with sepsis • Appreciate the Pathophysiology and complexity of the bodies immune system in fighting infection • Review clinical considerations in diagnosis and treatment of septic patient

  11. References

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