septic shock
TRANSCRIPT
SEPTIC SHOCK : DIAGNOSIS
AND TREATMENT
- Anira Iqbal
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3 Stages
Sepsis – Infection in blood + Inflammation in body
Severe sepsis – Organ failure + Blood clots (Gangrene)
Septic shock – BP drops + MOF
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Diagnosis - What stage?
• Bacteria in blood
• Clotting of blood in blood vessels• Dec O2sat levels • Inc waste products in blood• Abnormal liver and kidney functions• Electrolyte imbalance
• BP not corrected by fluid admin.
SEPSIS
SEVERE SEPSIS
SEPTIC SHOCK
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Tests1. Blood test – Culture Lactic acid level Platelets O2 level2. Urine test – Infection3. Wound secretion test4. Mucus secretion test5. CSF test 6. Indwelling catheter – sample
from lumen7. PCR – Microbial DNA in
blood/tissue
Still unconfirmed :1. X-ray (Lung)2. CT (Appendix,
pancreas, bowel)3. USG (GB, ovary)4. MRI (Soft tissue
abscess)
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Treatment : General Measures
Airway – IntubationBreathing – Mechanical ventilationCirculation – Fluids
Septic shockLA in bloodMetab acidosis Respiratory alkalosisHyperventilationMechanical ventilation + sedationdec O2 demand of resp muscles inc O2 delivery to hypoperfused tissues
Unresponsive patient?? Check glucose Low 1 ampoule of 50% dextrose iv
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Treatment :Specific measures
1. Remove source of infection2. Control infection – iv Antibiotics3. Inc BP – iv fluids Vasopressor agents4. Inflammation – Corticosteroids5. Inc O2 sat – Respirator6. Remove waste products – Dialysis7. Remove infected tissue – Surgery8. Packed RBC transfusion – if Hb<7gm/dl
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Antibiotics
As soon as blood sample taken for culture Gram positive + Gram negative org After culture reports, specific therapy Usually, monotherapy preferred over combination Exception – Pseudomonas aeruginosa – AG + Beta-L
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Vasoactive therapy1. Norepinephrine iv infusion – Inc MAP2. Epinephrine – Severe shock3. Dopamine – Low dose – D, beta agonist – Inc GF, inc
HR, Inc cardiac contractility. High dose – alpha agonist – Peripheral vasoconstriction
4. Vasopressin – R on Smooth muscle cells – Periph VC + potentiates effect of catecholamines
CorticosteroidsLow dose 1. Hydrocortisone2. Alpha-Fludrocortisone
Activated Protein C (Drotrecogin-alpha) – Antithrombotic, Profibrinolytic, antiinflammatory
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PrognosisSevere sepsis – 20 – 35% dieSeptic shock – 40 - 60% die
APACHE II (Acute Physiology and Chronic Health Evaluation II) : is a severity-of-disease classification system.AgeTemperature (rectal)Mean arterial pressurepH arterialHeart rateRespiratory rateSodium (serum)Potassium (serum)CreatinineHematocritWhite blood cell countGlasgow Coma Scale
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Prevention
Dec no. of invasive procedures Limit use of catheters More aggressive treatment of nosocomial infections Avoid indiscriminate use of corticosteroids and Antibiotics
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THANK YOU!!