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Sepsis: Difference between revisions
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<section begin="pathophysiology" /><section begin="clinical biochemistry" />'''Sepsis''' is an acute life-threatening condition characterised by organ dysfunction caused by a dysregulated host response to infection, usually bacterial. It’s related to [[systemic inflammatory response syndrome]] (SIRS) in pathomechanism. It has a very high mortality rate and can lead to [[multiple organ dysfunction syndrome]] (MODS) and death.<section end="clinical biochemistry" /> | <section begin="A&IC" /><section begin="pathophysiology" /><section begin="clinical biochemistry" />'''Sepsis''' is an acute life-threatening condition characterised by organ dysfunction caused by a dysregulated host response to infection, usually bacterial. It’s related to [[systemic inflammatory response syndrome]] (SIRS) in pathomechanism. It has a very high mortality rate and can lead to [[multiple organ dysfunction syndrome]] (MODS) and death.<section end="clinical biochemistry" /> | ||
'''Septic shock''' is defined as “A subset of sepsis in which underlying circulatory and cellular or metabolic abnormalities lead to substantially increased mortality risk.” As the name implies it implies the state where a person has sepsis and circulatory shock, often of the distributive type. A person is said to be in septic shock if: | '''Septic shock''' is defined as “A subset of sepsis in which underlying circulatory and cellular or metabolic abnormalities lead to substantially increased mortality risk.” As the name implies it implies the state where a person has sepsis and circulatory shock, often of the distributive type. A person is said to be in septic shock if: | ||
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The most common primary infection that leads to sepsis is pneumonia, especially community-acquired pneumonia. The pathogen is more frequently gram positive than gram negative; fungal, viral or parasitic etiology is rare. | The most common primary infection that leads to sepsis is pneumonia, especially community-acquired pneumonia. The pathogen is more frequently gram positive than gram negative; fungal, viral or parasitic etiology is rare. | ||
Bacteraemia is found in 50% of cases of sepsis. | Bacteraemia is found in 50% of cases of sepsis.<section end="A&IC" /> | ||
== Pathomechanism == | == Pathomechanism == | ||
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As fluid is lost to the interstitium, intravascular hypovolaemia occurs. DIC occurs due to endothelial dysfunction and intravascular hypovolaemia. Widespread tissue ischaemia and decreased tissue oxygenation causes widespread cell injury and thereby multisystem organ dysfunction. | As fluid is lost to the interstitium, intravascular hypovolaemia occurs. DIC occurs due to endothelial dysfunction and intravascular hypovolaemia. Widespread tissue ischaemia and decreased tissue oxygenation causes widespread cell injury and thereby multisystem organ dysfunction. | ||
<section begin="A&IC" /> | |||
== Clinical features == | == Clinical features == | ||
* Fever | * Fever | ||
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Empiric antibiotic treatment should begin immediately after blood cultures has been drawn; mortality increases the longer the patient goes without antibiotic therapy. The goal should be to administer antibiotics within 1 hour of recognition of the diagnosis. Any source of infection, like foreign bodies, abscesses or infected wounds should be assessed and treated appropriately. | Empiric antibiotic treatment should begin immediately after blood cultures has been drawn; mortality increases the longer the patient goes without antibiotic therapy. The goal should be to administer antibiotics within 1 hour of recognition of the diagnosis. Any source of infection, like foreign bodies, abscesses or infected wounds should be assessed and treated appropriately. | ||
Depending on the patient’s condition, fluid therapy, intubation and/or vasopressors might be necessary to maintain ventilation and circulation. | Depending on the patient’s condition, fluid therapy, intubation and/or vasopressors might be necessary to maintain ventilation and circulation.<section end="A&IC" /> | ||
Specific steps of management: | Specific steps of management: | ||
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** [[Venous thromboembolism]] ([[UFH]] or [[LMWH]]) | ** [[Venous thromboembolism]] ([[UFH]] or [[LMWH]]) | ||
** Stress [[Peptic ulcer disease|ulcer]] ([[PPI]]) | ** Stress [[Peptic ulcer disease|ulcer]] ([[PPI]]) | ||
<section end="A&IC" /> | |||
<section end=" | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Pathology]] | [[Category:Pathology]] | ||