05: Septic Shock

SIRS

Systemic inflammatory response syndrome; disproportionate inflammatory response or lack of immune regulation

MODS

Multiple organ dysfunction syndrome; physiologic derangements of organs as SIRS progresses

DIC

Disseminated intravascular coagulation; results in microvascular thrombosis

Normal initial inflammatory responses to damaged/diseased tissue

Vasodilation and increased vascular permeability

How does shock take inflammation and make it bad

It takes a local vasodilatory/permeability response and makes it systemic → refractory hypotension and fluid loss

T/F: SIRS = sepsis

F; other inflammatory things can cause SIRS

T/F: bad infection = sepsis

F; not every bad infection produces the inflammation required to classify it as sepsis

Non-infectious causes of SIRS

• Trauma

• Burns

• Pancreatitis

Sepsis definition

Clinical diagnosis associated with excessive inflammation in response to an infection

Most common infectious cause of sepsis

Bacteremia

How does inadequate perfusion cause MODS

Hypoperfusion → tissue hypoxia → anaerobic metabolism → cell death → MODS

D_O2

Total amount of oxygen delivered to the body’s tissues per minute

V_O2

Total amount of oxygen removed/consumed from the blood per minute

Type of shock most associated with septic shock

Distributive shock

Distributive shock

Excessive vasodilation resulting in a relative hypovolemia

Classic perfusion parameter associated with septic shock

Brick red mucous membranes

Lab abnormalities commonly (but not always) seen with sepsis

• Left shift in neutrophil population

• Hyperlactatemia

• Clotting disorders

Classes of medications contraindicated in septic patients and why

Steroids and NSAIDs → risk of GI ulcers and immunosuppression when they really need it

Big three bacteria you will diagnose

• Staphs

• Streps

• E. coli (and friends)

Common types of pyogenic bacteria

• Staphs

• Streps

• Trueperella

Why are Staphylocooci and Streptococci infections so common

Lots of staphs are opportunistic normal flora

Morphology of Enterobacteriaceae (AKA coliform) bacteria

Gram - rods

Common types of coliform bacteria

• E. coli

• Salmonella

• Yersinia

• Klebsiella

• Shigella

What defines different E. coli pathotypes

Different adhesins and surface antigens, which give the pathotypes different site predilections and disease presentations

Common type of strict anaerobe infection

Clostridium infections

Virulence factor that is a common driver of Clostridial infections

Exotoxins

Type of bacteria that causes granulomatous diseases

Mycobacterium

Classes of vector borne bacteria

Rickettsiaceae and Anaplasmataceae