sepsis

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SEPSIS DR UNNIKRISHNAN P / CCU

Post on 12-Dec-2014

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Enumerates the latest advancements in the management of sepsis and the search into its pathophysiology.

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  • 1. SEPSIS
    DR UNNIKRISHNAN P / CCU

2. .
SEPSIS AT ITS INCEPTION IS DIFFICULT TO RECOGNIZE BUT EASY TO TREAT; LEFT UNATTENDED IT BECOMES EASY TO RECOGNIZE BUT DIFFICULT TO TREAT
Machiavelli
3. 4. INFECTION
.
5. BACTEREMIA
6. SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
Generalized inflammatory response of the body to a variety of clinical conditions including infection, but not limited to infection
2 or more of the following
7. SIRS
8. SEPSIS
SIRS due to infection
9. SEVERE SEPSIS
Sepsis associated with organ dysfunction, hypoperfusion or hypotension
May include lactic acidosis,oliguria,altered mentation
10. ORGAN DYSFUNCTION
Arterial hypotension
SBP 1.5 x upper value
15. MODS
Presence of altered organ function lasting for > 24 hrs in an acutely ill patient, such that homeostasis cant be maintained without intervention.
16. Organ wise
17. HOW?
18. True or false..?
The immune response by the host is minimal in sepsis..
19. Sepsis and septic shock
Bacterial infection
Excessive host response
Host factors lead to cellular damage
Organ damage
Death
20. PATHOGENESIS
21. Theevents..
22. Coagulation and sepsis
23. .
24. MANAGEMENT
25. Be on the lookout for disaster
26. INITIAL RESUSCITATION [1st 6 hrs]
Central venous pressure (CVP): 812 mm Hg / 12-15 if mechanical ventilation
Mean arterial pressure (MAP) >65 mm Hg
Urine output >0.5 mL/kg/hour
Central venous (superior vena cava) or mixed venous oxygen saturation >70% or >65%, respectively
27. if central venous oxygen saturation not achieved
FLUID
PRBC ( Hct>30)
DOBUTAMINE: max 20/kg/min
28. DIAGNOSIS
29. BLOOD CULTURE
30. ANTIBIOTICS
31. SOURCE IDENTIFICATION/CONTROL
32. HEMODYNAMIC SUPPORT
33. VASOPRESSORS
34. INOTROPES
35. STEROIDS
Poorly responsive hypotension
Hydrocortisone > dexamethasone
Hydrocortisone 25
37. BLOOD PRODUCTS
38. PLATELETS
39. MECHANICAL VENTILATION-ARDS
40. MECHANICAL VENTILATION-ARDS
41. SEDATION- ANALGESIA- NMB
42. GLUCOSE CONTROL
43. GLUCOSE CONTROL
44. RENAL REPLACEMENT
Intermittent HD = CVVH
CVVH if hypotension
45. Bicarbonate therapy
Not for hypoperfusion induced lactic acidemiawith pH >7.15
46. DVT PROPHYLAXIS
47. STRESS ULCER PROPHYLAXIS
48. SEPSIS RESUSCITATION BUNDLE- 6 h
49. SEPSIS MANAGEMENT BUNDLE 24HR
50. OUTCOME IMPROVED BY
Early goal directed therapy
Lung protective ventilation
Appropriate antibiotic coverage
Activated protein C
Tight control of sugars 80-100mg/dl
Steroids
51. A clinician, armed with the sepsis bundles, attacks the three heads of severe sepsis: hypotension, hypoperfusion and organ dysfunction
52. THANK YOU
.
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