SEPSIS: SCOPE OF THE PROBLEM

Ugly Truth:

• 750,000 die from sepsis each year
• Greater Mortality than Stroke, MI, and Trauma Combined!

WHERE DO WE GO FROM HERE?

• Know the Process
• Know the Signs
• Know The Semantics
• Kknow the Treatment

Layman's Pathophys

THE PIPES (veins/arteries/cap beds)

• Increased Vasodilation-Pipes get Bigger leading to Lower Blood Pressure

THE PIPES

• Increased Venodilation Leading to Decreased Venous return and Decreased Cardiac Preload

THE PUMP (CARDIAC )

• Inflammatory Mediator release leads to Myocardial Depression and decreased Ejection Fractions

The Fluid

• Increased Capillary Permeability Leads to Leakier Vessels and Progressive Intravascular Volume Loss

End Result

• Distributive Shock
• Hypovolemic Shock
• Cardiogenic Shock
• Multi Organ Failure

Know the Semantics

SIRS

• Fever or Hypothermia
• Tachycardia
• Tachypnea
• Leukocytosis

Sepsis=SIRS plus Infection

• Known or Suspected Infection

SEVERE SEPSIS

• Sepsis PLUS Acute Organ Dysfunction
• CNS-Altered LOC/Confusion
• Hematologic-Coagulopathy/Thrombocytopenia
• Genitourinary-Decreased Urine Output/Increased Creatinine Above Baseline
• Integument-Mottled skin/Cyanotic Nail Beds

SEVERE SEPSIS

• Hepatic-Increased LFT's
• Endocrine-Hyper or Hypoglycemia
• Respiratory-Impaired Oxygenation (don't be fooled by the pulse ox)
• Cardiovascular-Hypotension

SEPTIC SHOCK

• SBP
• MAP
• Lactate >4
• Despite Adequate Volume Resuscitation

The Treatment

EARLY ABX!

• For Every 1 Hour delay of ABX in the hospital, mortality rate increases by 7%
• Draw Blood Cultures if at all Possible before Administration of ABX-Don't delay ABX if cultures can't be drawn

SOURCE CONTROL

FLUID RESUSCITATION

STABILIZE THE MAP

• Central Line Placement if Necessary
• Initiation of vasopressors-Levophed is generally the accepted first choice.
• GOAL MAP: > 65

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