1.2 Medicine II_Sepsis and Septic Shock 2014a

July 23, 2012 Sepsis and Septic Shock: What’s Hot; What’s Out? Dr. Panaligan

Hello! This will be a very shocking topic. Shocking sa haba! Shocking sa dami! Haha! We tried to make it concise but this is the best we can do. So, let’s get shocked together! – Boy Gulat, 2014A

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SEPSIS: A COMPLEX DISEASE

Severe Sepsis: sepsis associated with dysfunction of organ(s) distant from the site of infection, hypoperfusion, or hypotension Septic Shock: sepsis with hypotension that, despite adequate fluid resuscitation, requires pressor therapy. In addition, there are perfusion abnormalities that may include lactic acidosis, oliguria, altered mental status and acute lung injury.

Notes:  Severe Sepsis: sepsis associated with dysfunction of organ(s) distant from the site of infection, there is also a sign of hypoperfusion, or hypotension (most of the time, the organ involved is the kidney hence knowing when  This Venn diagram provides a conceptual framework to the patient last voided and what was the urine volume view relationships between various components of is a part of the evaluation. It is very important to ask sepsis: infection, non-infectious disorders, SIRS, sepsis, these questions since this will give you an idea whether and severe sepsis. the patient already has severe sepsis even there is no  The inflammatory changes in sepsis are tightly linked to manifestation of hypotension) disturbed hemostasis.  Septic Shock: sepsis with hypotension that, despite adequate fluid resuscitation, requires pressor therapy or Notes: inotropic therapy. In addition, there are perfusion  Sepsis is a complex disease which consists of infection abnormalities, that may include lactic acidosis, oliguria, and other manifestations related to systemic altered mental status and acute lung injury (Even if inflammatory response syndrome. there is fluid challenge and you already give fluid to  Systemic inflammatory response syndrome is related to increase the pressure and to maintain hemodynamics, homeostasis or hemodynamic stability (SIRS). It has there is still persistent hypotension. You now start with other non-infectious causes including acute inotropic support or therapy such as dobutamine, pancreatitis, trauma, and burn. dopamine, and norepinephrine. This patient could  A screening tool has been devised to really know already be labeled having septic shock). whether the patient really has sepsis but you may have an overdiagnosis of sepsis in patients who do not have ACCP/SCCM Consensus Definitions an infection. Infection  Inflammatory response to microorganisms, or SIRS: MORE THAN JUST A SYSTEMIC  Invasion of normally sterile INFLAMMATORY RESPONSE tissues  SIRS: A clinical response arising from a nonspecific Systemic  Systemic response to a variety insult manifested by 2 of the following: Inflammato of processes 1. Fever or hypothermia: Temperature: 38°C orry Response 36° Syndrome 2. Tachycardia: HR: 90 beats/min  Infection plus 3. Tachypnea: Respirations: 20/min or PaCO2 120 mg/dL) in arterial PO2 → increasing alveolar epithelial the absence of diabetes (Despite the absence of injury and capillary permeability → increased diabetes, usually there is an elevated blood sugar pulmonary water content → decreases level in patients with severe infection) pulmonary compliance and interferes with Unexplained change in mental status – Even if oxygen exchange. there is no identified source of infection but the  In the absence of pneumonia or heart failure, progressive diffuse pulmonary infiltrates and patient has fever and unexplained change in arterial hypoxemia (PaO2/FIO2,