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Sepsis

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Sepsis

  1. 1. Alonso Rafael Arroyo CastilloResidente Medicina Interna Uninorte 2012
  2. 2.  Unificar conceptos . Me basta con que logremos al final de la charla, aprender a identificar la sepsis. Pero quedaría satisfecho si y solo si, aprendemos a manejar la sepsis de la forma correcta.
  3. 3. SEPS  Proceso de descomposición de los  cuerpos orgánicos proteicos faltos  de vida, en condiciones  anaeróbicas, con producción de  gases fétidos.
  4. 4. Actualización del marco conceptual y manejo de la sepsis, sepsis severa y shock séptico, Juan Carlos Gómez Rodríguez, M.D, revista med17(1):116-129, 2009 .
  5. 5. Actualización del marco conceptual y manejo de la sepsis, sepsis severa y shock séptico, Juan Carlos Gómez Rodríguez, M.D, revista med17(1):116-129, 2009 .
  6. 6. Actualización del marco conceptual y manejo de la sepsis, sepsis severa y shock séptico, Juan Carlos Gómez Rodríguez, M.D, revista med17(1):116-129, 2009 .
  7. 7. Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  8. 8. Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  9. 9.  Incidencia 240 casos/100000/año = 660 mil casos/año. (National Hospital Discharge Survey). Mortalidad del 28%. 70-80% casos en US 1990-2000, se dió en pactes hospitalizados por otras razones. La sepsis grave es 100 veces + frecuente en > 85 años. ( Angus).
  10. 10. Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  11. 11. Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  12. 12. Barrera física Barrera química Barrera celularSepsis: la otra cara de la respuesta inmune, Juan Pablo Zapata Ospina, Iatreia Vol 24(2): 179-190. Junio-agosto 2011.Sepsis: Definiciones y Aspectos Fisiopatológicos, Indira Briceño M.D. Medicrit 2005; 2(8):164-178.Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  13. 13.  Inflamación depende de: 1. Vasodilatación. 2. Aumento de la permeabilidad vascular. 3. Migración leucocitaria.Sepsis: la otra cara de la respuesta inmune, Juan Pablo Zapata Ospina, Iatreia Vol 24(2): 179-190. Junio-agosto 2011.Sepsis: Definiciones y Aspectos Fisiopatológicos, Indira Briceño M.D. Medicrit 2005; 2(8):164-178.Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  14. 14. VasodilataciónSepsis: la otra cara de la respuesta inmune, Juan Pablo Zapata Ospina, Iatreia Vol 24(2): 179-190. Junio-agosto 2011.Sepsis: Definiciones y Aspectos Fisiopatológicos, Indira Briceño M.D. Medicrit 2005; 2(8):164-178.Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  15. 15. Permeabilidad vascularSepsis: la otra cara de la respuesta inmune, Juan Pablo Zapata Ospina, Iatreia Vol 24(2): 179-190. Junio-agosto 2011.Sepsis: Definiciones y Aspectos Fisiopatológicos, Indira Briceño M.D. Medicrit 2005; 2(8):164-178.Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  16. 16. Migración leucocitaria SE SP TNF Quimiocinas, productos de degradación bacteriana y complemento ( IL8, LPS, C5)Sepsis: la otra cara de la respuesta inmune, Juan Pablo Zapata Ospina, Iatreia Vol 24(2): 179-190. Junio-agosto 2011.Sepsis: Definiciones y Aspectos Fisiopatológicos, Indira Briceño M.D. Medicrit 2005; 2(8):164-178.Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  17. 17. TNF, IL1, IL2, IFN IL10, IL4, IL6, FCT-B, anti IL1Sepsis: la otra cara de la respuesta inmune, Juan Pablo Zapata Ospina, Iatreia Vol 24(2): 179-190. Junio-agosto 2011.Sepsis: Definiciones y Aspectos Fisiopatológicos, Indira Briceño M.D. Medicrit 2005; 2(8):164-178.
  18. 18. Cadena o Lípido a + LBP LBP-LPS SISTEMA ANTICITOCINAS: •Glucocorticoides •Anti IL1 •FCT-BSepsis: la otra cara de la respuesta inmune, Juan Pablo Zapata Ospina, Iatreia Vol 24(2): 179-190. Junio-agosto 2011.Sepsis: Definiciones y Aspectos Fisiopatológicos, Indira Briceño M.D. Medicrit 2005; 2(8):164-178.Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  19. 19. Sepsis: la otra cara de la respuesta inmune, Juan Pablo Zapata Ospina, Iatreia Vol 24(2): 179-190. Junio-agosto 2011.Sepsis: Definiciones y Aspectos Fisiopatológicos, Indira Briceño M.D. Medicrit 2005; 2(8):164-178.
  20. 20. Complejo XaVa (protrombina) ¿ Qué disminuye la proteína C en la sepsis?Sepsis: la otra cara de la respuesta inmune, Juan Pablo Zapata Ospina, Iatreia Vol 24(2): 179-190. Junio-agosto 2011.Sepsis: Definiciones y Aspectos Fisiopatológicos, Indira Briceño M.D. Medicrit 2005; 2(8):164-178.Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  21. 21. Sepsis: la otra cara de la respuesta inmune, Juan Pablo Zapata Ospina, Iatreia Vol 24(2): 179-190. Junio-agosto 2011.Sepsis: Definiciones y Aspectos Fisiopatológicos, Indira Briceño M.D. Medicrit 2005; 2(8):164-178.Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  22. 22.  Es importante identificar factores que generen inmunocompromiso.  Fiebre o hipotermia.  Alteración del estado de conciencia.  taquicardia.  Disnea y signos congestivos pulmonares.  Disfunción ventricular izda.  Disfunción diastólica.  Oliguria.  Íleo adinámico.  Leucocitosis, neutrofilia, trombopenia, elevación de los tiempos.  Hipo glicemia, hiperbilirrubinemia.  Ectima gangrenoso  Manifestaciones con relación al órgano lesionado.Sepsis: la otra cara de la respuesta inmune, Juan Pablo Zapata Ospina, Iatreia Vol 24(2): 179-190. Junio-agosto 2011.Sepsis: Definiciones y Aspectos Fisiopatológicos, Indira Briceño M.D. Medicrit 2005; 2(8):164-178.Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  23. 23.  Historia clínica.  Debo evaluar la clínica y las variables generales, inflamatorias, de disfunción orgánica, hemodinámicas y de perfusión tisular, para hacer diagnóstico y clasificación.  Pancultivos ( IC)  Estudios de imagen en búsqueda de foco de infección (IC)  Se deben solicitar para clínicos para evaluar la función de cada órgano o sistema vital.Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  24. 24. Guia del residente en la uci, 2008; Ricardo Abizanda Campos, servicio medicina intensiva, hospital universitario asociado general de casteló.
  25. 25.  MODS: imposibilidad para mantener homeostasis sin intervención terapéutica.  IOM: alteración o anormalidad funcional grave, adquirida en al menos 2 aparatos o sistemas, que dure un mínimo de 24 a 48 horas.Mandell, Robert S Munford, section E, pags 987-1005, Sepsis .
  26. 26. Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  27. 27. Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.Mandell, Robert S Munford, section E, pags 987-1005, Sepsis.
  28. 28. 1. Resucitación inicial ( 6 horas ). 2. Antibioticoterapia. 3. Identificación y control del sitio de infección. 4. Fluidoterapia. 5. Vasopresores. 6. Terapia inotrópica. 7. Esteroides. 8. Proteina c activada recombinante. 9. Manejo transfusional. 10. Ventilación. 11. Sedo-analgesia y bloqueo neuromuscular. 12. Control glicémico. 13. Terapia de reemplazo renal. 14. Bicarbonato. 15. Profilaxis de tvp y de ulceras de stress.Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  29. 29. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  30. 30. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  31. 31. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  32. 32. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  33. 33. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  34. 34. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  35. 35. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  36. 36. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  37. 37. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  38. 38. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  39. 39. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  40. 40. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  41. 41. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  42. 42. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, critical medical care2008.
  43. 43. Alonso Rafael Arroyo CastilloResidente Medicina Interna Uninorte 2012

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