Septic Shock - PATRI CK DUFF, M.D. SEPTI C SHOCK OVERVI EW...

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Unformatted text preview: PATRI CK DUFF, M.D. SEPTI C SHOCK OVERVI EW Etiology Microbiology Pathophysiolo gy Diagnosis Management SEPTI C SHOCK I MPACT Results in approximately 215,000 deaths annually in the U.S. Similar in frequency to MI as a cause of death SEPTI C SHOCK PREDI SPOSI NG FACTORS Extended hospitalization Advanced age Debilitating illness I mmunodeficiency disorder Ventilator > 48 h SEPTI C SHOCK PREDI SPOSI NG FACTORS Disseminated malignancy Hyperalimentation Biliary tract surgery Genital tract surgery SEPTI C SHOCK MORTALI TY Underlying Illness Underlying Illness Mortality % Mortality % Rapidly fatal Rapidly fatal 80 80 Ultimately fatal Ultimately fatal 40 40 Non-fatal Non-fatal <10 <10 SEPTI C SHOCK MI CROBI OLOGY The Perfect Storm SEPTI C SHOCK PATHOPHYSI OLOGY Endotoxin stimulation of humoral and cellular immune systems activation of complement sequence and coagulation cascade SEPTI C SHOCK PATHOPHYSI OLOGY Activation of coagulation cascade activation of fibrinolytic system DI C SEPTI C SHOCK PATHOPHYSI OLOGY Complement activation chemotaxis of PMNs, degranulation of mast cells, and release of histamine and inflammatory mediators increased capillary permeability SEPTI C SHOCK PATHOPHYSI OLOGY I NFLAMMATI ON release of catecholamines and prostaglandins generalized vasoconstriction SEPTI C SHOCK PATHOPHYSI OLOGY VASOCONSTRI CTI ON decreased perfusion of vital organs tissue hypoxia metabolic acidosis SEPTI C SHOCK PATHOPHYSI OLOGY METABOLI C ACI DOSI S capillary pooling decreased circulating blood volume decreased venous return decreased cardiac output SEPTI C SHOCK PATHOPHYSI OLOGY DECREASED CARDI AC OUTPUT decreased coronary and cerebral blood flow intractable hypotension, coma, multiorgan failure DEATH SEPTI C SHOCK CLI NI CAL MANI FESTATI ONS Altered mental status Thermal instability Cardiac dysfunction Respiratory compromise SEPTI C SHOCK CLI NI CAL MANI FESTATI ONS Bleeding Jaundice I leus Skin changes SEPTI C SHOCK...
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Septic Shock - PATRI CK DUFF, M.D. SEPTI C SHOCK OVERVI EW...

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