Septic_Shock - Response to foreign body Response...

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Unformatted text preview: Response to foreign body Response Inflammatory reaction – Localized – Generalized Generalized inflammatory reaction – Infective – Noninfective Sepsis: Generalized inflammatory, having Sepsis: systemic signs systemic Systemic Inflammatory Response Syndrome (SIRS) Response Patient presents with two or more of the Patient two following criteria. – temperature > 38°C or < 36°C – heart rate > 90 beats/minute heart – respiration > 20/min or PaCO2 < 32mm Hg – leukocyte count > 12,000/mm3, < leukocyte 4,000/mm3 or > 10% immature (band) cells Definition Definition Sepsis: SIRS plus a documented plus infection site (documented by positive culture for organisms from that site). Blood cultures do NOT need to be positive. NOT While SIRS, sepsis, and septic shock are associated commonly with bacterial infection, bacteremia may not be present. infection, Septic Shock: Sepsis-induced Septic hypotension despite fluid resuscitation PLUS hypoperfusion abnormalities PLUS The infection site helps in determining the most likely cause of a patient's sepsis The Suspected Source of Sepsis Major Community Major Acquired Pathogens Acquired Major Nosocomial Major pathogens pathogens Lung Abdomen Skin/Soft Tissue Streptococcus Streptococcus pneumoniae pneumoniae Haemophilus Haemophilus influenzae influenzae Legionella sp. Chlamydia Chlamydia pneumoniae pneumoniae Escherichia coli Bacteroides fragilis Streptococcus Streptococcus pyogenes pyogenes Staphylococcus Staphylococcus aureus aureus Clostridium sp. Clostridium sp. Polymicrobial Polymicrobial infections infections Aerobic gram negative bacilli Pseudomonas Pseudomonas aeruginosa aeruginosa Anaerobes Staphylococcus sp. Aerobic gram negative bacilli Aerobic gram negative bacilli Anaerobes Candida sp. Staphylococcus Staphylococcus aureus aureus Aerobic gram negative bacilli Urinary Tract CNS Escherichia coli Klebsiella sp. Enterobacter sp. Proteus sp. Streptococcus Streptococcus pneumoniae pneumoniae Neiserria Neiserria meningitidis meningitidis Listeria Listeria monocytogenes monocytogenes Escherichia coli Haemophilus Haemophilus influenzae influenzae Aerobic gram negative bacilli Enterococcus sp. Enterococcus sp. Pseudomonas Pseudomonas aeruginosa aeruginosa Escherichia coli Klebsiella sp. Klebsiella sp. Staphylococcus sp. Staphylococcus sp. Mechanism Organ Dysfunctions associated with Severe Sepsis and Septic Shock: Severe Lungs: early fall in arterial PO2, capillary-leakage Lungs into alveoli; tachypnea, hyperpnea (ARDS). Kidneys :(acute renal failure): oliguria, anuria, azotemia, proteinuria Liver: elevated levels of serum bilirubin, alkaline Liver phosphatase,cholestatic jaundice Heart: cardiac output is initially normal or Heart elevated, Brain : confusion Brain Organ Dysfunctions contd: Organ Digestive tract: nausea, vomiting, diarrhea Digestive and ileus Skin: ecthyma gangrenosum (think ecthyma gangrenosum Pseudomonas aeruginosa in neutropenic patients), Petechia or purpura: (think Neisseria meningitidis or meningitidis Rickettsia rickettsia: (if evidence of tick bite)), Hemorrhage or bullous lesions Toxic Shock Syndrome: Staphylococcus aureus or Streptococcus pyogenes aureus Streptococcus Complications: Complications: Adult respiratory distress syndrome (ARDS) Disseminated Intravascular Coagulation (DIC) Acute Renal failure (ARF) Intestinal bleeding Liver failure Central Nervous system dysfunction Heart failure Death When to suspect When Fever or unexplained signs with Fever malignancy or instrumentation Hypotension Oliguria or anuria Tachypnea or hyperpnea Hypothermia without obvious cause Bleeding High fever and bounding pulse, rigor, purpuric rash, tachypnoea purpuric THERAPY THERAPY Immediate Stabilization of the Patient. The blood must be rapidly cleared of microorganisms microorganisms The original focus of infection must be treated. treated ...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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