Sepsis resident survival guide: Difference between revisions
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:* There is no definitive biomarkers have been associated with the endothelial dysfunction of sepsis. | :* There is no definitive biomarkers have been associated with the endothelial dysfunction of sepsis. | ||
'''SIRS''' diagnosed by '''2''' or more of the following: | '''SIRS''' is diagnosed by '''2''' or more of the following: | ||
::*[[Tachycardia]] > 90 bpm | ::*[[Tachycardia]] > 90 bpm | ||
::*[[Tachypnea]] > 20 breaths per minute or on [[blood gas]], a P<sub>a</sub>CO<sub>2</sub> < 32 mm Hg | ::*[[Tachypnea]] > 20 breaths per minute or on [[blood gas]], a P<sub>a</sub>CO<sub>2</sub> < 32 mm Hg | ||
| Line 18: | Line 18: | ||
::*[[White blood cell]] count < 4000 cells/mm³ or > 12000 cells/mm³ (< 4 x 10<sup>9</sup> or > 12 x 10<sup>9</sup> cells/[[litre|L]]), or > 10% band forms (immature white blood cells / bandemia). | ::*[[White blood cell]] count < 4000 cells/mm³ or > 12000 cells/mm³ (< 4 x 10<sup>9</sup> or > 12 x 10<sup>9</sup> cells/[[litre|L]]), or > 10% band forms (immature white blood cells / bandemia). | ||
'''[[Sepsis]]'''diagnosed by at least '''1'''of the following signs of organ failure: ['''HOME'''] | '''[[Sepsis]]''' is diagnosed by at least '''1'''of the following signs of organ failure: ['''HOME'''] | ||
::*'''H'''ypoxemia (arterial oxygen tension [PaO2] < 72 mm Hg at fraction of inspired oxygen [FiO2] 0.21; overt pulmonary disease not the direct cause of hypoxemia) | ::*'''H'''ypoxemia (arterial oxygen tension [PaO2] < 72 mm Hg at fraction of inspired oxygen [FiO2] 0.21; overt pulmonary disease not the direct cause of hypoxemia) | ||
::*'''O'''iguria (urine output < 30 mL or 0.5 mL/kg for at least 1 h) | ::*'''O'''iguria (urine output < 30 mL or 0.5 mL/kg for at least 1 h) | ||
| Line 24: | Line 24: | ||
::*'''E'''levated plasma lactate level > 4mg | ::*'''E'''levated plasma lactate level > 4mg | ||
: | '''Severe Sepsis''' | ||
::*[[Sepsis]] + organ dysfunction | |||
::*Organ damage can present as decreased urine output, acute kidney injury, and elevated liver function tests. | |||
'''Multiple Organ Dysfunction Syndrome''' ('''MODS''') is the presence of altered organ function in a acutely ill patient whom homeostasis cannot be maintained without intervention. | |||
'''Septic Shock''' | |||
::*Severe sepsis + persistent [[hypotension]] after adequate fluid challenge. | |||
==Causes== | ==Causes== | ||
Revision as of 20:20, 26 November 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Definition
- Sepsis = Infection + SIRS
- The presence of systemic inflammatory syndrome (SIRS) is due to many factors. The presence of infection increases the chances of sepsis and increase the SIRS criteria .
- The endothelial dysfunction is the main trigger transforming the localized infection into systemic organ dysfunction
- There is no definitive biomarkers have been associated with the endothelial dysfunction of sepsis.
SIRS is diagnosed by 2 or more of the following:
- Tachycardia > 90 bpm
- Tachypnea > 20 breaths per minute or on blood gas, a PaCO2 < 32 mm Hg
- Temperature < 36 (96.8 °F) or > 38 °C (100.4 °F)
- White blood cell count < 4000 cells/mm³ or > 12000 cells/mm³ (< 4 x 109 or > 12 x 109 cells/L), or > 10% band forms (immature white blood cells / bandemia).
Sepsis is diagnosed by at least 1of the following signs of organ failure: [HOME]
- Hypoxemia (arterial oxygen tension [PaO2] < 72 mm Hg at fraction of inspired oxygen [FiO2] 0.21; overt pulmonary disease not the direct cause of hypoxemia)
- Oiguria (urine output < 30 mL or 0.5 mL/kg for at least 1 h)
- Mental status alteration
- Elevated plasma lactate level > 4mg
Severe Sepsis
- Sepsis + organ dysfunction
- Organ damage can present as decreased urine output, acute kidney injury, and elevated liver function tests.
Multiple Organ Dysfunction Syndrome (MODS) is the presence of altered organ function in a acutely ill patient whom homeostasis cannot be maintained without intervention.
Septic Shock
- Severe sepsis + persistent hypotension after adequate fluid challenge.
Causes
Life Threatening Causes
Common Causes
Management
Aggressive therapy with hemodynamic monitoring