Septicemia
presence of pathogens and toxins in blood
Bacteremia
presence of bacteria and toxins in the blood
sepsis
whole body inflammation caused by infection
SIRS Criteria
(any two)
- temp greater than100.4 or less than 95.0
- RR greater than 22 or PaCO2 less than 32
- HR greater than 90
- WBC greater than 12,000 or less than 4,000
SIRS
Systemic Inflammatory Response Syndrome
- a systemic inflammatory response
- typically an immune response to infection but not always
MEWS and PEWS
- modified early warning system
- pediatric early warning signs
- like SIRS criteria but may include more/fewer signs
Sepsis is the result of…
an infection
With sepsis, the infection is…
uncontrolled or spreads and releases bacteria or toxins into the blood
- this triggers the systemic inflammatory response
- sepsis is SIRS caused by an infection
Sepsis is ____ caused by an infection
SIRS
Cascade of Sepsis
- when inflammatory response becomes exaggerated, inflammation, and coagulation increase
- leads to microthrombi and obstruction of capillaries
- endothelial (vein/arterial wall) damage, vasodilation, and increased capillary permeability
Severe Sepsis
- if sepsis is not controlled it enters what we call severe sepsis
- this is sepsis with one organ system damaged or experiencing failure
DIC
Disseminated Intravascular Coagulation
- widespread activation of clotting which causes clots in small blood vessels
- leads to a drop in tissue perfusion which can lead to tissue and organ damage, failure
- sepsis is one of the leading causes of DIC
Even though DIC is characterized by excessive clotting in the intravascular space, the patient is actually at a very high risk for bleeding. Why do you think that is?
increased clotting depletes the platelets and clotting factors needed to control bleeding, causing excessive bleeding.
DIC Tx
- monior VS, clotting factors
- S/S of hemorrhage, bleeding
- Fix hypovolemia
- Possibly platelet transfusions
- possibly heparin, especially prophylactly when DIC is slowly evolving. Not when it is quick
What is shock?
-generally it is when there is insufficient blood flow to meets the body’s demands (lack of perfusion)
Septic Shock
- severe sepsis with persistent hypotension which is unresponsive to fluid replacement therapy and organ system damage and/or failure to 2 or more organ systems.
- MODS (multiple organ dysfunction syndrome)
- very high mortality rate
Organ systems because damaged during septic shock as a result of…
- decreased tissue perfusion
- hypotension
- microvascular occlusion (DIC)
Compensatory Shock
- Stage 1
- Baroreceptors detect drop in MAP
- SNS kicks in, ups HR, and cardiac contraction
- Peripheral vasoconstriction
- Perfusion of systems is maintained due to this
- Signs are nearly imperceptible
Progressive Shock
- Stage 2
- Sustained drop in MAP
- Compensatory mechanisms from stage 1 are still active, but unable to keep MAP up
- Vasoconstriction actually starts to limit blood flow
- lactic acid builds up causing acidosis
- sodium-potassium pump of cells fails, leads to loss of intracellular K, Na, and water move in
- cells swell up from Na and water, causes organelle damage
Refractory Shock
- Stage 3
- Tissue damage and lack of O2 become so widespread that tissues and organs fail and die
- Even if MAP is restored, damage has become too widespread to prevent organ death
Early signs of Septicemia
- Hypotension
- rapid, thready pulse
- quick, deep respirations
- warm, flushed skin
- alert and oriented x3
- normal urine output
- elevated temp
Late signs of Septicemia
- hypotension
- Tachycardia, possible arrhythmias
- rapid, shallow respirations, dyspnea
- cool, pale, edematous
- lethargic, possible comatose
- oliguria or anuria
- decreased temp
Initial tx
- will be early goal directed resuscitation therapy
- fluid challenge of 30mL/kg of crystalloid solution (NS, D51/2, LR)
- vasopressors (vasopressin, dopamine, norepi)
- goal is to raise MAP, HR, urine output more than 0.5mL/kg/hr
Albumin
- may see albumin admin along with crystalloid IVFs
- idea is that albumin acts as an anti-inflammatory and anti-oxidant and helps maintain plasma osmolarity
- however, benefits compared to only admin crystalloid IVFs are virtually non existent and there is a risk of complications when admin albumin
