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pathophysiology basics
Dr.T.V.Rao MD
Dr.T.V.Rao MD
Background
In 1914, Schottmueller wrote, Septicaemia is a state of microbial invasion from a portal of entry into the blood stream which causes sign of illness. The definition did not change much over the years, because the terms sepsis and septicaemia referred to several ill-defined clinical conditions present in a patient with bacteraemia.
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Shock: Types
Hypovolemic Septic (high CO, low SVRI) Cardiogenic (high CVP) Neurogenic Anaphylactic Adrenal insufficiency
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Definitions
Infection: microbial phenomenon
characterised by an inflammatory response to the presence of micro organisms or the invasion of normally sterile host tissue by these organisms Bacteraemia: the presence of bacteria in the bloodstream
Definition
Shock:- When the cardiovascular system fails to deliver enough oxygen and nutrients to meet cellular metabolic needs. Sepsis:- Presence of bacteria in the blood stream. Septic Shock:- Begins with the development of septicaemia usually from bacterial infections, but can be viral in origin. This is the most common type of Distributive Shock.
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Bone, R., Balk, R., Cerra, F., Dellinger, R., Fein, A., Knaus, W., Schein, R., et al. (1992). Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Dr.T.V.Rao MDCommittee. American College of Chest Physicians/Society of Critical Care Medicine. Chest, 101(6), 16441655.
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Sepsis
Severe Sepsis Septic Shock
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Terminology
Systemic Inflammatory Response Syndrome (SIRS)
Temp > 38 or < 36 HR > 90 RR > 20 or PaCO2 < 32 WBC > 12 or < 4 or Bands > 10%
TWO out of four criteria acute change from baseline
Sepsis
The systemic inflammatory response to infection.
Severe Sepsis
Organ dysfunction secondary to Sepsis. e.g. hypoperfusion, hypotension, acute lung injury, encephalopathy, acute kidney injury, coagulopathy.
Septic Shock
Hypotension secondary to Sepsis that is resistant to adequate fluid administration and associated with hypoperfusion.
Bone, R., Balk, R., Cerra, F., Dellinger, R., Fein, A., Knaus, W., Schein, R., et al. (1992). Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Dr.T.V.Rao MDCommittee. American College of Chest Physicians/Society of Critical Care Medicine. Chest, 101(6), 16441655.
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Pathophysiology
The nidus of infection: Localized infections ( otitis, pneumonia, meningitis etc.,) Colonization of mucosal and invasion ( Hib, menigococci) Occult bacteremia ( 3mo to 3 years ) Nosocomial : at risk patients
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Parasite
Virus
Infection
Fungus
Severe Sepsis
shock
Sepsis
SIRS
Severe SIRS Trauma
Bacteria
BSI
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Burns
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Lung 47%
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Septic Shock
Septic shock- once a uniformly fatal condition with 100% mortality. Present recovery rates are up to 50%. Significance: Frequent occurrence and high mortality.
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Death
Extremely likely Very likely Somewhat likely Not very likely Not likely at all Not sure
Microbial Triggers
Gram-negative bacteria: lipopolysaccharide Gram-positive bacteria Lipoteichoic acid/cell wall muramyl peptides Superatigens Staphylococcal Toxic Shock Syndrome Toxin, TSST Streptococcal pyrogenic exotoxin , SPE
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TNF-A
LPS
LBP
ENDOTHELIAL CELL
LPS
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Management of Sepsis
Recognition Supportive care Source control Antibiotics Specific (adjunctive) therapy
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Brave and Committed Nurses, Doctors Save Many Lives in spite of Shock
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Programme Created by Dr.T.V.Rao MD for Basic understanding in Septic Shock for Medical Students in the Developing World
Email doctortvrao@gmail.com
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