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  • Septic Shock

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    hongjosh
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    Septic Shock Epidemiology mortality 45% gm neg risks: DM, lymphoprolif do's, cirrhosis, burns, invasive devices, chemo Fungemia risk: immunocompromised Pathophysiology Host response: cytokines, TNF, interleukins, PAF, kinins Cardiac: vasodilation - CO maintained or Inc in early sepsis ARDS may occur minutes to

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    Septic Shock Epidemiology mortality 45% gm neg risks: DM, lymphoprolif do's, cirrhosis, burns, invasive devices, chemo Fungemia risk: immunocompromised Pathophysiology Host response: cytokines, TNF, interleukins, PAF, kinins Cardiac: vasodilation - CO maintained or Inc in early sepsis ARDS may occur minutes to

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    48 vizualizări1 pagină

    Septic Shock

    Încărcat de

    hongjosh
    Septic Shock Epidemiology mortality 45% gm neg risks: DM, lymphoprolif do's, cirrhosis, burns, invasive devices, chemo Fungemia risk: immunocompromised Pathophysiology Host response: cytokines, TNF, interleukins, PAF, kinins Cardiac: vasodilation - CO maintained or Inc in early sepsis ARDS may occur minutes to

    Drepturi de autor:

    Attribution Non-Commercial (BY-NC)
    Descărcați ca DOC, PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    din 1

    Septic Shock

    Epidemiology
    mortality 45%
    gm neg risks: DM, lymphoprolif do’s, cirrhosis, burns, invasive devices, chemo
    gm pos risks: vasc catheters, indwelling devices, burns, IV drugs
    Fungemia risk: immunocompromised

    Pathophysiology
    Host response: cytokines, TNF, interleukins, PAF, kinins
    Cardiac: vasodilation - CO maintained or Inc in early sepsis
    Diminished response to volume replacement
    ARDS may occur minutes to hours after sepsis
    ARF
    DIC, thrombocytopenia (30%)

    Tx: ABC’s
    First - keep O2 sat >90
    Correcte hypotension with 500cc bolus’s q 15 min- may need 5-6 L
    Use DA 5-20 mcg/kg/min or NE
    Keep MAPS > 60
    Remove source: Catheters, Abscesses...
    Empiric Abx: AFTER cultures
    Adults: 3rd gen ceph (ceftriaxone 1g, cefotax 2g, ceftaz 2g)
    OR antipsudomonal blactamse
    Also: aminoglycoside
    Immunocomp: ceftaz g, imipenem 750mg, or meropenem 1g
    gram pos - vancomycin added
    if anaerobic (intraaabdominal, genital, odonto, nectrotizing - metronidazole or
    clinda 900
    If legionella - erythromycin
    Acidosis - tx c O2, IVF - bicarb if severe
    DIC - FFP 15-20cc/kg, keep PT at 1.5-2, the platelets
    adrenal insuff - hydrocortisone 100mg IV

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