Sepsis and septic shock

SEPSIS AND SEPTIC SHOCK PATHOPHYSIOLOGY DIAGNOSIS INITIAL MANAGEMENT Last update OCTOBER 2010

Spectrum of Disease Severity With Progression From Inflammation to Shock

What is Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

How Does the Body Fight Shock? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Mean Arterial BP MAP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pathophysiology of Sepsis ,[object Object],[object Object],[object Object],[object Object]

Determinants of Severity in Sepsis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Bacterial Factors ,[object Object],[object Object],[object Object],[object Object],[object Object]

Hypotension= MAP< 60 / SBP< 90 Goals are adequate perfusion = Lactic acid < 18 or Urine Output responds to fluid ,[object Object],[object Object],[object Object],[object Object]

Organs Commonly Affected ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

DEGREES OF SEVERITY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Systemic Inflammatory Response Syndrome SIRS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Patients Who Present With SIRS WHAT DO I DO ,[object Object],[object Object],[object Object],[object Object]

Early Treatment for SIRS/SEPSIS ,[object Object],[object Object],[object Object]

Early Treatment for SIRS/SEPSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fluid Goals/Endpoints ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Empiric Antibiotics for Suspected SIRS / Sepsis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Sepsis LACTATE < 36 mg/dl AND EVIDENCE OF ONLY 1 OR NONE signs of ORGAN DYSFUNCTION ,[object Object],[object Object],[object Object],[object Object]

Severe Sepsis SEPSIS PLUS TWO OR MORE ABNORMAL VALUES REPRESENTING SEVERE ORGAN DYSFUNCTION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Septic Shock Severe Sepsis with Sx/Sx of 2 or more Organ Dysfunction WITH NO RESPONSE TO FLUID BOLUS ADMIT TO ICU FOR GOAL DIRECTED THERAPY ,[object Object],[object Object],[object Object],[object Object]

SEPSIS & SEPTIC SHOCK ,[object Object],[object Object],[object Object],[object Object],[object Object]

EARLY TREATMENT FIND THE SOURCE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

EARLY TREATMENT ,[object Object],[object Object],[object Object],[object Object],Crit Care Med. 2006 Jun;34(6):1589-96

Empiric Antibiotics Should be initiated within 1 hour ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

AIRWAY & BREATHING ,[object Object],[object Object],[object Object]

Circulation / Hypoperfusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Start @ 20ml/Kg Continue with 500 ml NS Q 30 Until goals met OR Pulmonary Edema Stop @40-60ml/Kg ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PULMONARY EDEMA ARDS & ALI Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object]

“ PULMONARY EDEMA” ARDS & ALI Diagnosis ALI & ARDS The same except for PaO2 ratio ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

FLUIDS FAIL TO IMPROVE BP/Perfusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pyelonephritis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Am J Obstet Gynecol 1991 Feb;164(2):587-90 Baillieres Clin Obstet Gynaecol 1994 Jun;8(2):353-73.

ANTIBIOTICS & PYELONEPHRITIS ,[object Object],[object Object]

ANTIBIOTICS & PYELONEPHRITIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Post treatment Suppression ,[object Object],[object Object],[object Object],[object Object],[object Object]

EARLY RECOGN I T I ON ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CBC, Lactate, BC Consider IV fluids and ABX SBP ≤ 90? yes no Lactate high? 20 ml/kg fluid bolus 18-35 mg/dl IV fluids Consider ABX Repeat lactate in 6 hrs < 18 mg/dl Document Septic Shock (Time Zero) ≥ 36 mg/dl SBP ≤ 90 SBP >90 stop Suspected Sepsis Document Severe Sepsis (Time Zero)

Step 2: Sepsis Resuscitation: The Golden Hours

Sepsis and septic shock

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Sepsis and septic shock