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Septic shock /certified fixed orthodontic courses by Indian dental academy
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Septic shock /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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    Septic shock /certified fixed orthodontic courses by Indian dental academy Septic shock /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • Management of Septic Shock INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    • Septic Shock • Septic shock- once a uniformly fatal condition with 100% mortality. • Present recovery rates are upto 50%. • Significance: Frequent occurrence and high mortality. www.indiandentalacademy.com
    • Septic Shock I. Introduction. II. Pathophysiology III. Clinical Manifestations IV. Management www.indiandentalacademy.com
    • Introduction. • What is shock? Shock is a state of acute disruption of circulatory function, resulting in insufficiency of tissue perfusion,oxygen utilization and cellular energy producion. Low BP is NOT sine qua non of shock. www.indiandentalacademy.com
    • Septic Shock I. Introduction. II. Pathophysiology III. Clinical Manifestations IV. Management www.indiandentalacademy.com
    • Pathophysiology • The nidus of infection: – Localised infections ( otitis, pneumonia, meningitis etc.,) – Colonization of mucosal and invasion ( Hib, menigococci) – Occult bacteremia ( 3mo to 3 years ) – Nosocomial : ‘at risk patients’ www.indiandentalacademy.com
    • Pathophysiology The Pathogen: • Neonates: GBHS, enterobacteriacae, listeria, Staph aureus, HSV. • Infants: Hib, Strep pneumoniae, Staph aureus. • Children:Strep pneumoniae, N.meningitidis, S.aureus, enterobacteriacae, Hib. • Immunocompromised: Enterobacteriacae,Staph, Pseudomonas, Candida. www.indiandentalacademy.com ‘Pathophysiology’
    • Pathophysiology • The agent - host interaction leads to ‘CHAOS’ www.indiandentalacademy.com
    • Pathophysiology • What ‘type of shock’ is septic shock? Septic shock has features of : – Hypovolemic shock – Cardiac shock – Distributive shock. www.indiandentalacademy.com
    • Septic Shock I. Introduction. II. Pathophysiology III. Clinical Manifestations IV. Management www.indiandentalacademy.com
    • Clinical Manifestations. The Continuum of infection to MODS and Death (Clinical Definitions) www.indiandentalacademy.com
    • Clinical Manifestations. Recognition of Septic Shock: • Inflammatory triad– Fever – Tachycardia – flushed skin Warm Shock • Hypoperfusion – – – – Altered sensorium Urine output >CFT www.indiandentalacademy.com Wide pulse pressure.......bounding pulses
    • Clinical Manifestations. • Hypotension – – – – – – – Cold and clammy skin Mottling Tachycardia Cyanosis Narrow pulse pressure Hypoxemia Acidosis. www.indiandentalacademy.com Cold shock
    • Clinical Manifestations. Staging of Septic Shock: I. Compensated / Preshock / Hyperdynamic II.Decompensated / Organ hypoperfusion III. End organ failure / Irreversible www.indiandentalacademy.com
    • Septic Shock I. Introduction. II. Pathophysiology III. Clinical Manifestations IV. Management www.indiandentalacademy.com
    • Management Prevention: 1. Immunisation 2. Prompt treatment of local infections 3. Hospitalized patient: look out for nidus of infection- IV lines, catheters, E.tubes www.indiandentalacademy.com
    • Management Recognise septic shock early: • Remember- Inflammatory triad Signs of hypoperfusion • Do not wait for the BP to fall ! • Lower limit for systolic BP = 70 +( age x 2) www.indiandentalacademy.com
    • Management. • Two means of death: 1. Shock. 2. Multi organ failure. • Aims of treatment: 1. Assure perfusion of critical vascular beds. ( cerebral, coronary, renal) 2. Rx underlying cause. www.indiandentalacademy.com
    • Management STEPS 1. Prevent / correct hypoxemia: Supplement oxygen 95-100%. 2. IV access: peripheral vein. 3. If IV access fails: Intraosseous line. 4. Fluid resuscitation: 20mL/Kg NS or RL as bolus, repeat upto 60 mL/Kg. End point : Improved perfusion. www.indiandentalacademy.com
    • Management STEPS Improved perfusion => a. CFT b. Warmth c. Strong pulses d. mental status e. Tachycardia f. BP (ideal = 90 + age x 2; Min = 70+ age x 2) g. Urine output. www.indiandentalacademy.com
    • Management STEPS 5. Establish a 2nd IV line for Dopamine infusion (Draw blood for culture) 6. Administer IV antibiotics <2 mo:Ampicillin + gentamicin or Ampicillin+ceftriaxone/cefataxime >2mo: Ceftriaxone or Cefotaxime alone or www.indiandentalacademy.com Ampicillin + Chloramphenicol
    • Management STEPS 7. Correct metabolic derangement: – Metabolic acidosis. – Hyper or hypoglycemia : always correct hypoglycemia. www.indiandentalacademy.com
    • Management STEPS 8. DIC: • Restoration of normovolemia reverses abnormal activation. • ‘Component replacement’ (Goal - Normal PT, PTT, fibrinogen, PC = 40,000 to 1 Lakh/cumm.) a. FFP - most beneficial in early stages. b. Cryo- consider 1 unit/3 units of FFP transfused. www.indiandentalacademy.com c. Platelet concentrate
    • Management STEPS 9. Recognize and manage organ failure: a. Cardiovascular support: Rate & rythm- correct 02, acidosis, Ca, Mg, K variations Stroke volume - fluid correction & replace losses Ionotrope support. www.indiandentalacademy.com
    • Management STEPS 9. Recognize and manage organ failure: b. Renal: Volume replacement Low dose dopamine ?diuretic with vol expansion Indications for dialysis: Hyperkalemia refractory metabolic acidosis Anuria despite diuresis www.indiandentalacademy.com BUN>100mg%
    • Management STEPS 9. Recognize and manage organ failure: c. Respiratory support: Supplement 02, Early intubation and PPV ( PEEP) d. GI: Antacids, sucralfate, early enteral nutrition. www.indiandentalacademy.com
    • Monitoring a Child With Septic Shock. • Frequent monitoring is MOST IMPORTANT to recognise and Rx complications. 1. Pulse 5. Urine output. 2. BP 6. ABG 3. Level of consciousness 7. PT/PTT/PC 4. 02 saturation www.indiandentalacademy.com 8. CVP
    • Management- summary. Five important points 1. ABC, supplement 02 always. 2. IV or IO access and fluid resuscitation upto 60 mL/Kg. 3. Early dopamine infusion @10µg/Kg/min 4. Empirical antibiotic. 5. Frequent monitoring. www.indiandentalacademy.com
    • References 1.Nelson TB of Pediatrics. 16th edn. 2.Medical Emergencies in ChildrenMeharban singh 3.PALS: 1997, AAP & AHA. 4.PCNA: Intensive Care. 1987. 5.TB of Pediatric Critical Care- P.R.Holbrook 6.Handbook of PIC- Rogers & Hefaler 7.Various Speakers: Critical Care CME, May www.indiandentalacademy.com 2002
    • Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com