by ESSAM A. SALEMICU REGISTRARE,Meeqat General hospital madina

3. Sepsis :
Is a clinical syndrome of life-
threatening organ dysfunction
caused by a dysregulated
response to infection

5. :Septic shocks
Is a subset of sepsis with significantly
increased mortality due to severe
abnormalities of circulation andor
cellular metabolism
Involves persistent hypotension (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
<

7. Etiology :
Predisposing factors include:
. Diabetes mellitus
. Cirrhosis
. Leukopenia
. Leukopenia
. Invasive

9. Pathophysiology :
Initially , arteries and arterioles dilate , decreasing
peripheral arterial resistance ; cardiac output typically
increases . This stage has been referred to as warm
shock
Even in the stage of increased cardiac output
,vasoactive mediators cause blood flow to bypass
capillary exchange vessels ( a distributive defect )
Coagulopathy may develop because of intravascular
coagulation with consumption of major clotting factors ,
excessive fibrinolysis in reaction thereto , and more
often a combination of both .

11. Signs and symptoms :
Sepsis:
. Temp : >38.3 C
. Heart rate > 90 beats/minute
.respiratory rate : > 20 breath/minute
. Diaphoresis
. WBC > 15000 UL , <4000 , or 10% bands
Septic shock:
Sepsis sign+
. Confusion
. Decrease aletrness
. Dyspnea
. Warm skin cool and pale extremeties ( later sign )
. Peripheral cyanosis and mottling.
. oliguria

14. . Perfusion restored with IV fluids and
sometimes vasopressors
. O2 support
. Broad-spectrum antibiotics
. Source control
. Supportive measures ( eg, corticosteroids ,
insulin)

15. Patients with septic shock should be
treated in an ICU . The following should be
monitored hourly :
. CVP , PAOP , or ScvO2
. pulse oximetry
. ABGs
. Blood glucose , lactate , and electrolyte levels
. Urine output , a good indicator of renal
perfusion

17. Perfusion restoration :
. Target ScvO2 is 70%
. Target CVP reaches 8 mmHg -12
mmHg ( 10 cm H2O ) for non ventilated
patient .
. Norepinephrine or vasopressin – to
maintain MAP 60 mmHg
. Correction of albumine level
≤
≤

19. Other supportive measures
:
. Normalization of glucose – IV infusion (1-4
units/hr) to maintain glucose between 110 – 180
mg/dl . See glucose control protocol in ICU
. Corticoisteroid therapy – hydrocortisone 50 mg IV
q 6 h (or 100 mg q 8 h)
. DVT prophylaxis
. PUD prophylaxis
. Sedation in ICU
. Delirium management

21. Key points :
. Sepsis and septic shocks are increasingly severe clinical
syndromes of life-threatening organ dysfunction caused by a
dysregulated response to infection
. An important component is critical reduction in tissue perfusion ,
which can lead to acute failure of multiple organs , including the
lungs , kidneys , and liver

22. . Early recognition and treatment is
the key to improved survival
. Resuscitate with IV fluids and
sometimes vasopressors titrated to
optimize central venous oxygen
saturation ( ScvO2) and preload , and
lower serum lactate levels

23. . Control the source of infection by
removing catheters , tubes , and infected
and/or necrotic tissue and by draining
abscesses
. Give empiric broad-spectrum antibiotics
directed at most likely organisms and
switch quickly to more specific drugs
based on culture and sensitivity results
Correction of serum albumine