严重脓毒症和感染性休克PPT.ppt

dengzide@163.com CLINICAL FEATURES CUTANEOUS Direct bacterial involvement of the skin/ underlying soft tissue Cellulitis/fasciitis Lesions occurring as a consequence of sepsis/hypotension/DIC Acrocyanosis/necrosis of peripheral tissues Lesions secondary to infective endocarditis Microemboli/immune complex vasculitis Diagnosis Diagnosis of Septic Shock Serious Infections Pneumonia / acute pyelonephritis /acute abdomen / meningitis Atypical Presentation Elderly/ immune compromised / very young No fever/ no localized infection source Differential Diagnosis All other nonseptic causes of shock RECOGNITION OF SHOCK Pulse Rate Respiratory Rate Capillary Refill Pulse Pressure Skin and core temperature Mental Status Urine Output Clinical Presentation Generalized Septic Shock Vital signs Blood pressure : SBP of 90 mm Hg with evidence of inadequate organ perfusion Pulse : 100 per minute Respiratory rate: 20 per minute Temperature: 38 degrees Centigrade or 36 degrees Centigrade (rectal temperature is most accurate in ED) EPIDEMIOLOGY EPIDEMIOLOGY Both gram-negative and gram-positive bacteria account for majority of sepsis cases Microbial blood invasion is not essential Most frequent sites of infection Lungs Abdomen Urinary Tract EPIDEMIOLOGY Fungemia Immunocompromised patients Patient Males Females Age- Older adults 55-60 years old Predisposing factors of DM/CA EPIDEMIOLOGY Factors that predispose to gram-negative bacteremia Diabetes mellitus / liver cirrhosis / burns chemotherapy / invasive procedures Factors that predispose to gram-positive bacteremia Vascular catheters / IV drug abuse Indwelling mechanical devices / burns PATHOPHYSIOLOGY PATHOPHYSIOLOGY Starts as a focus of infection Results in either blood stream invasion or proliferation of the organism at the infected site Release of large amount of exogenous toxins Exotoxins Endotoxins Other components PATHOPHYSIOLOGY Body’s response is the release of Vasoactive Mediators Nitric Oxide Endogenous mediato