Professional Documents
Culture Documents
Objectives
Vignette
Q:
What is the
differential diagnosis?
Definitions
T > 38 C or <36 C
HR > 90 beats/min
RR > 20 breaths/min or pCO2 < 32 mmHg
WBC >12,000 cells/mm3, <4,000 cells/mm3, or >10% bands
Definitions
Vignette
Vignette
CBC:
ABGs:
Electrolytes:
BUN 98 mg/dL
Creat 5.4 mg/dL
Q:
What is the
precise diagnosis now?
Predisposing Underlying
Diseases
E. coli
Klebsiella pneumonia
Proteus
Pseudomonas
Gram-positive cocci
Gram-negative anaerobes
Cirrhosis
Alcoholism
Encapsulated organisms
Pneumococcus spp.,
Haemophilus influenzae,
Neisseria meningtidis,
Capnocytophagia
canimorsus Babesiosis
Vibrio, Yersinia, and
Salmonella spp., other
Gram-negative rods (GNRs),
encapsulated organisms
Klebsiella spp.,
pnemococcus
Diabetes
Steroids
Neutropenia
T-cell
abnortmalities
Vignette
The patient persists on mechanical ventilation
with 100% FiO2.
No urine output has been reported.
V/S: BP: 88/56 mmHg; HR: 122/min; RR:
28/min; T: 34 degrees
A thermal blanket is placed and the nephrologist
is consulted
Q:
International initiative:
To reduce mortality rate
To improve standards of care
To secure adequate funding
Initial Resuscitation
Fluid Resuscitation
Vassopressors
Inotropic Therapy
Vignette
PRIOR TO ANTIBIOTICS:
Diagnosis!!!
Antibiotic Therapy
Antibiotic Therapy
Antibiotic Therapy
Urosepsis
Intra-abdominal infection
Pneumonia
Antibiotic Therapy
CNS infection
Skin infection
Endocarditis
depending on organism
Source control
Drainage of abscess
Debridement of infected necrotic tissue
Removal of infected device
GI perforation
Intestinal ischemia
Vignette
Q:
What other
strategies are
recommended in the
treatment of sepsis?
Corticosteroids
Activated Protein C
<5,000
5,000-30,000 + risk of bleeding
>50,000 for surgery of invasive procedure
Glucose Control
DVT Prophylaxis
Vignette
Q:
Q:
What would be
done if the course had
been different?
References