Sepsis is a life-threatening condition caused by the body's response to an infection. It occurs when an infection you already have triggers a chain reaction throughout your body. Sepsis is diagnosed when a person has both an infection and signs of a systemic inflammatory response. Treatment involves administering broad-spectrum antibiotics intravenously, giving intravenous fluids, and using vasopressors if blood pressure is too low. Preventive measures include vaccinations, early nutrition, immunonutrition, and proper wound and infection care.
3. OBJECTIVES
After completing this module, learner should able
to understand:
Sepsis and septic shock.
Over all incidence of sepsis.
How to assess level of risk in patients.
Which investigations to perform in a patients
with possible sepsis.
Treatment modalities and supportive therapies.
Preventive mesure
4. INTRODUCTION
Sepsis is a potentially life-threatening
condition caused by the body's response to
an infection.
Sepsis : Defining a disease continuum.
Infection/Traum
a
SIRS Sepsis Severe Sepsis
6. SIRS
SIRS – systemic inflammatory response
syndrome
Must have at least 2 of the following:
Temperature >38.5ºC or <36ºC
Heart rate >90 beats/min
Respiratory rate >20 breaths/min or PaCO2 <32
mmHg
WBC >12,000 cells/mm3, <4000 cells/mm3, or >10
% immature (band) forms
SIRS is the body’s response to infection,
inflammation, stress.
8. a fever above 101ºF (38ºC) or a temperature
below 96.8ºF (36ºC)
heart rate higher than 90 beats per minute
breathing rate higher than 20 breaths per
minute
probable or confirmed infection
9. SEVERE SEPSIS
patches of discolored skin
decreased urination
changes in mental ability
low platelet (blood clotting cells) count
problems breathing
abnormal heart functions
chills due to fall in body temperature
unconsciousness
10. RISK FACTORS
Older adults
Pregnant women
Are very young or very old
Have a compromised immune system
Have diabetes or cirrhosis
Are already very sick, often in a hospital intensive
care unit
Have wounds or injuries, such as burns
Have invasive devices, such as intravenous catheters
or breathing tubes
Have previously received antibiotics or corticosteroids
11. SIGN AND SYMPTOMS
Change in mental status
A first (upper) number in a blood pressure
reading — also called the systolic pressure
— that's less than or equal to 100 millimeters
of mercury (mm Hg)
Respiratory rate higher than or equal to 22
breaths a minute
12. DIAGNOSIS
Urine. If your doctor suspects that you have a urinary tract infection, he or she may want to
check your urine for signs of bacteria.
Wound secretions. If you have a wound that appears infected, testing a sample of the wound's
secretions can help show what type of antibiotic might work best.
Respiratory secretions. If you are coughing up mucus (sputum), it may be tested to determine
what type of germ is causing the infection.
Imaging tests
If the site of infection is not obvious, your doctor may order one or more of the following imaging
tests:
X-ray. X-rays are good for visualizing problems in your lungs.
Computerized tomography (CT). Infections in your appendix or pancreas are easier to see on
CT scans. This technology takes X-rays from a variety of angles and combines them to depict
cross-sectional slices of your body's internal structures.
Ultrasound. This technology uses sound waves to produce real-time images on a video monitor.
Ultrasound may be particularly useful to check for infections in your gallbladder or ovaries.
Magnetic resonance imaging (MRI). MRIs may be helpful in identifying soft tissue infections.
This technology uses radio waves and a strong magnet to produce cross-sectional images of the
internal structures of your body.
13. SEPSIS CRITERIA
fever of more than 100.4°F (38°C) or less
than 96.8°F (36°C)
heart rate of more than 90 beats per minute
respiratory rate of more than 20 breaths per
minute or arterial carbon dioxide tension
(PaCO2) of less than 32 mm Hg
abnormal white blood cell count
14. SOFA SCORE
Respiration: PaO2/FiO2 or SaO2/FiO2
Coagulation: Platelets
Liver: Bilirubin
Cardiovascular: Hypotension or vasopressor
CNS: GCS
Renal: Creatinine or urinary output
15. QUICK SEQUENTIAL ORGAN FAILURE
ASSESSMENT (QSOFA).
It uses the results of three criteria:
low blood pressure.
high respiratory rate (greater than 22 breaths
per minute)
Glasgow coma scale score of less than 15
16. SIRS
•Infectious &
non infectious
causes
•Clinical
response
arising from a
non specific
insult
Sepsis
•SIRS plus
•Presumed
or
confirmed
infection
Severe Sepsis
•Sepsis plus
•Sepsis-induced
organ
dysfunction or
tissue
hypoperfusion
Septic Shock
•Sepsis-induced
hypo-perfusion or
hypotension
persisting despite
30 mls/kg fluid
rescusitation
17. TREATMENT
Antibiotics. Treatment with antibiotics should begin immediately. Initially
you'll receive broad-spectrum antibiotics, which are effective against a
variety of bacteria. The antibiotics are administered intravenously (IV).
After learning the results of blood tests, your doctor may switch to a
different antibiotic that's targeted to fight the particular bacteria causing
the infection.
Intravenous fluids. People who have sepsis often receive intravenous
fluids right away, usually within three hours.
Vasopressors. If your blood pressure remains too low even after
receiving intravenous fluids, you may be given a vasopressor
medication, which constricts blood vessels and helps to increase blood
pressure.
Other medications you may receive include low doses of corticosteroids,
insulin to help maintain stable blood sugar levels, drugs that modify the
immune system responses, and painkillers or sedatives.
Antimicrobial therapy
18. NEW MODALITIES
Fibrates (fenofibrates) are used anti-
inflammatory activities through peroxisome
proliferator-activated receptor alpha
activation.
Levosimendan.
salbutamol, aliskiren, amiodarone, lithium,
montelukast, alpha-lipoic acid, and sildenafil
19. PREVENTIVE MEASURES
Vaccinations.
Early enteral or oral nutrition should be taken
Immunonutrition (arginine, omega-3 fatty acids,
nucleotides)
Insulin therapy
Get medical care immdiately.
Oral antiseptics for mouth care
Caring for wounds
Coated vascular catheters
Treating infections
Hand washing
Proper care during chronic infection.
20. SUPPORTIVE THERAPY
Hemodynamic stabilization
Renal replacement therapy
Airway management and ventilation
Adjunctive therapy
Recombinant activated protein C (rhAPC)
Antithrombin
Immunoglobulins
Selenium.
21. OTHER SUPPORTIVE THERAPIES
Deep venous thrombosis (DVT) prophylaxis
Nutrition and metabolic control
Enteral vs. parenteral nutrition
Glutamine
Ulcer prophylaxis
Use of bicarbonate in lactic acidosis
Blood products
Erythropoietin
