Introduction to Severe Sepsis, Septic Shock - Introduction to General Medicine - Lecture Slides, Slides for Medicine. Eternal University

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Description: Introduction to Severe Sepsis, Septic Shock, Systemic Inflammatory Response Syndrome, Tachypnea, Acute Organ Dysfunction, Metabolic Acidosis, Refractory Hypotension, Fluid Resucitation are some points in Introduction to General Medicine lecture. This lecture is one of 61 lectures you can find here for this course.
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Slide 1

Introduction

Severe Sepsis and Septic Shock are major healthcare problems

High mortality Increasing in incidence APPROPRIATED AND RAPID

MANAGEMENT INFLUENCE THE OUTCOME

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Introduction

SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SRIS):

2 o more of:

Fever: oral temperature >38C or hypothermia (<36C)

Tachypnea: >24 breaths/min Tachycardia: heart reat >90 beats/min

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Introduction

SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SRIS):

2 o more of:

Leukocytosis: WBC >12.000/ul, leukopenia <4000/ul, or >10% bands

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Introduction

SEPSIS:

SIRS in response to documented infection

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Introduction SEVERE SEPSIS: Sepsis with evidence of acute organ dysfunction CV: SBP <90 mmHg or MAP <70 mmHg RENAL: urine output <0.5 ml/kg/hr RESPIRATORY: PaO2/FIO2 <250 HEMATOLOGIC: platelet count <80.000/ul METABOLIC ACIDOSIS: pH <7.30 or plasma

lactate >2mmol/L

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Introduction

SEPTIC SHOCK:

Severe Sepsis with refractory hypotension: MAP <60 mmHg after fluid resucitation (30-50cc/Kg crystalloids)

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Introduction

Guidelines have been created to improve outomes in severe sepsis and septic shock

These Guidelines are evidence-based medicine methodology system

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International Guidelines – Sepsis

Initial Resuscitation

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Initial Resuscitation

Central Venous O2 Saturation:

SVO2 ?

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NEJM 2001; 345:1368-77

Early-Goal Directed Therapy in Sepsis

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Early-Goal Directed Therapy in Sepsis

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Initial Resuscitation

IF TIME IS MUSCLE IN CASE OF CARDIAC ISCHEMIC DISEASE.

TIME IS L I F E IN CASE OF SEPSIS

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Initial Resuscitation

During the first 6 hours, goals are:

CV pressure 8-12 mmHg. In mechanical ventilated patients or patients with known preexisting decreased ventricular compliance, target will be 12 – 15 mmHg

MAP > 65 mmHg Grade 1-B

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Initial Resuscitation

During the first 6 hours, goals are:

Urine output > 0.5 ml/kg/h

Central venous saturation (SVO2) > 70% Intermitent or continuous measurements of O2 are the same

Grade 1-B

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Initial Resuscitation

During the first 6 hours, goals are:

If SVO2 is not achieved with fluid resuscitation, through the CVC target, then transfusion of red blood cells to achieve Ht of 30%

After that, if no goal SVO2 is achieved, start Dobutamine

Grade 1-B

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International Guidelines – Sepsis

Diagnosis

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Diagnosis

Obtain appropriate cultures before antimicrobial therapy is initiated, if such cultures do not cause delay in antibiotic administration. Grade 1-C

Imaging studies should be performed promptly in attempts to confirm a potential source of infection

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International Guidelines – Sepsis

Antibiotic Therapy

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Antibiotic Therapy Critical Care Medicine 2006. 34, 6

Retrospective Cohort study 2731 patients with Septic Shock 50% of them received effective

antimicrobial administration within the first hour of documented hypotension

Increased survival was seen among them

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Antibiotic Therapy

IV antibiotic therapy must be started as early as possible and within the first hour of recognition of severe sepsis or septic shock

Broad spectrum therapy until the causative

organisms and susceptibilities are known

Evidence 1-C

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International Guidelines – Sepsis

Source of Control

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Source of Control

Specific anatomical diagnosis of infection requiring consideration of emergent source of control, should be sought and diagnosed as rapidly as possible and within the first 6 hours following presentation

Grade 1-C

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International Guidelines – Sepsis

Fluid Therapy

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Fluid Management in Sepsis

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Fluid Management in Sepsis

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Fluid Therapy

Fluid resuscitation could be done with either crystalloids or colloids.

Grade 1-B

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