Sepsis and septic shock March 2018 | by EMauthor
•Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. •Septic shock is defined as the need for vasopressors to maintain mean arterial pressure ≥ 65 mm Hg, and a serum lactate level >2 mmol/L despite adequate volume resuscitation. The concept of the systemic inflammatory response syndrome (SIRS) has long been used to identify early sepsis. However, SIRS criteria have been found to lack correlation increased mortality risk, which is the main consideration for using such a conceptual model. The SIRS response is often adaptive rather than pathologic. Etiology and predisposing factors •Diabetes mellitus •Cirrhosis •Leukopenia (especially that associated with cancer or treatment with cytotoxic drugs) •Invasive devices (including endotracheal tubes, vascular or urinary catheters, drainage tubes, and other foreign materials) •Prior treatment with antibiotics or corticosteroids •Common causative sites of infection include the lungs and the urinary, biliary, and GI tracts. Symptoms and Signs Patients typically have fever, tachycardia, diaphoresis, and tachypnea; BP remains normal. Other signs of the causative infection may be present. As sepsis worsens or septic shock develops, an early sign may be confusion or decreased alertness. BP decreases, yet the skin is paradoxically warm. Later, extremities become cool and pale, with peripheral cyanosis and mottling. Organ dysfunction causes additional symptoms and signs specific to the organ involved (eg, oliguria, dyspnea). Diagnosis •Clinical manifestations •BP, heart rate, and O2 monitoring •FBC, U&E, lactate •Invasive central venous pressure (CVP), PaO2 , and central venous O2 saturation (ScvO2 ) readings •Cultures of blood, urine, and other potential sites of infection, including wounds in surgical patients Sepsis is suspected when a patient with a known infection develops systemic signs of inflammation or organ dysfunction. Similarly, a patient with otherwise unexplained signs of systemic inflammation should be evaluated for infection by history, physical examination, and tests, including urinalysis and urine culture, blood cultures, and cultures of other suspect body fluids, or imaging. Ultimately, the diagnosis is clinical. Organ Dysfunction It is important to detect organ dysfunction as early as possible. A number of scoring systems have been devised, but the sequential organ failure assessment score (SOFA score) and the quick SOFA score (qSOFA) have been validated with respect to mortality risk and are relatively simple to use. The qSOFA criteria identify patients who should have further clinical and laboratory investigation (all 3 criteria must be present): •Respiratory rate ≥ 22/min •Altered mentation Systolic •BP ≤ 100 mm Hg |
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