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Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is followed by suppression of the immune system. Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.
Septic shock is a subclass of distributive shock, a condition in which abnormal distribution of blood flow in the smallest blood vessels results in inadequate blood supply to the body tissues, resulting in ischemia and organ dysfunction. Septic shock refers specifically to distributive shock due to sepsis as a result of infection.
Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.
Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infectionThe infection is most commonly by bacteria, but can also be by fungi, viruses, or parasitesRisk of death from sepsis being as high as 30%, severe sepsis as high as 50%, and septic shock as high as 80%The most common primary sources of infection resulting in sepsis are the lungs, the abdomen, and the urinary tract
- Clinical Features
- Differential Diagnosis
- Circulation Managment
- Infection Control
- Blood Products
- External Links
- See Also
Life-threatening organ dysfunction caused by a dysregulated host response to infection. This only needs to include one of the following: 1. HypotensionwithSBP <100 or 2. Altered mental statusor 3. Tachypnea (RR >/=22) OR 4. Increase in SOFA score by 2 points
Patients with sepsis and any of the following: 1. Vasopressorrequirement to maintain a mean arterial pressure > 65 mm Hg 2. Serum lactate level greater than 2 mmol/L (>18mg/dL) in the absence of hypovolemia.
1. CBC 2. Urinalysis/Urine culture 3. Blood culture 4. CXR 5. Chem 6. LFTs 7. Lipase 8. VBG 9. Lactate 10. Coags 11. Consider: 11.1. Procalcitonin 11.2. DIC panel (fibrinogen, D-dimer, FDP) 11.3. T&S 11.4. CT headand/or [[LP] 11.5. TSH (thyroid storm) 11.6. Cosyntropin stim vs. random cortisol (adrenal insufficiency) 11.7. Pelvic exam (toxic shock syndrome, tampon) 11.8. Influenzarapid testing 11.9. CT Abd/Pelvis (abscess, other) 11.10. spine imaging (epidural abscess, other)
1. Guidelines recommend initial 30 cc/kg bolus (generally 2L in average adult) 2. Reassess patient's volume status after initial bolus. Auscultate for pulmonary edema. Evaluate peripheral circulation. Consider IVC ultrasound 3. Septic patients can be euvolemic but remain hypotensive due to vasodilation. Consider early vasopressors. 4. Increasing evidence that excessive fluid resuscitation can be harmful. 4.1. Positive fluid balance on day 3 of hospital admission independently associated with...
1. Indicated if MAP<60 despite adequate IVF or if IVF are contraindicated 2. Best if given when the vascular space is filled; ok if it is not Options: 1. Norepinephrine(5-20mcg/min) - 1st line 2. Epinephrine(1-20 mcg/min) - 2nd line 3. Vasopressin (0.03 units/minute fixed dose) can be added to norepinephrine (NE) 3.1. as a 2nd line agent may reduce arrhythmia's compared to other pressors with catecholamine properties 4. Dopamine should be used hesitantly and only in highly selected patients (...
1. Dobutamine (2-20mcg/kg/min) may be added if: 1.1. Myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output 1.2. Ongoing signs of hypoperfusion, despite achieving adequate intravascular volume and adequate MAP
1. Remove any infected lines 2. Drain abscesses 3. Consult surgery or other specialists if indicated (e.g. for appendicitis, cholangitis, etc.)
1. Administer within 3 hours 2. Initial choice dependant on suspected source, local antibiogram, and severity of illness 3. See Initial Antibiotics in Sepsis (Main)
Only transfuse RBCs when hemoglobin decreases to <7.0 g/dL (goal is 7.0 –9.0 g/dL in adults)
Do not use erythropoietin as a specific treatment of anemia associated with severe sepsis
1. In severe sepsis, administer platelets prophylactically when counts are <10,000/mm3 (10 x 109/L) in the absence of apparent bleeding 2. If < 20,000/mm3 (20 x 109/L) and significant risk of bleeding then administer platelets. 3. <50,000/mm3 (50 x 109/L) if there is active bleeding, planned surgery or other procedures.
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Sepsis is caused by overwhelming response to an infection and leads to tissue damage, organ failure, and even death. The symptoms include confusion, shortness of breath, elevated heart rate, pain or discomfort, over-perspiration, fever, shivering, or feeling cold.
- Associated Symptoms
- Differential Diagnosis
- Selective Advantage
- Society and Culture
- Other Species
A fever is usually accompanied by sickness behavior, which consists of lethargy, depression, loss of appetite, sleepiness, hyperalgesia, and the inability to concentrate. Sleeping with a fever can often cause intense or confusing nightmares, commonly called "fever dreams". Mild to severe delirium (which can also cause hallucinations) may also present itself during high fevers.
Various patterns of measured patient temperatures have been observed, some of which may be indicative of a particular medical diagnosis: 1. Continuous fever, where temperature remains above normal throughout the day and does not fluctuate more than 1 °C in 24 hours (e.g. in lobar pneumonia, typhoid, meningitis, urinary tract infection, or typhus); 2. Intermittent fever, where the temperature elevation is present only for a certain period, later cycling back to normal (e.g., in malaria, leishmaniasis, pyemia, or sepsis); 3. Remittent fever, where the temperature remains above normal throughout the day and fluctuates more than 1 °C in 24 hours (e.g., in infective endocarditis, or brucellosis). Among the types of intermittent fever are ones specific to cases of malaria caused by different pathogens. These are: 1. Quotidian fever, with a 24-hour periodicity, typical of malaria caused by Plasmodium knowl...
Fever is a common symptomof many medical conditions: 1. Infectious disease, e.g., COVID-19, Dengue, Ebola, gastroenteritis, HIV, influenza, Lyme disease, malaria, mononucleosis, as well as infections of the skin, e.g., abscesses and boils. 2. Immunological diseases, e.g., relapsing polychondritis, autoimmune hepatitis, granulomatosis with polyangiitis, Horton disease, inflammatory bowel diseases, Kawasaki disease, lupus erythematosus, sarcoidosis, and Still's disease; 3. Tissue destruction, as a result of cerebral bleeding, crush syndrome, hemolysis, infarction, rhabdomyolysis, surgery, etc.; 4. Cancers, particularly blood cancers such as leukemia and lymphomas; 5. Metabolic disorders, e.g., gout, and porphyria;and 6. Inherited metabolic disorder, e.g., Fabry disease. Adult and pediatric manifestations for the same disease may differ; for instance, in COVID-19, one metastudy describes 92.8% of adults versus 43.9% of...
Scholars viewing fever from an organismal and evolutionary perspective note the value to an organism of having a fever response, in particular in response to infective disease. On the other hand, while fever evolved as a defense mechanism, treating fever does not appear to worsen outcomes. Studies using warm-blooded vertebrates suggest that they recover more rapidly from infections or critical illness due to fever. Other studies suggest reduced mortality in bacterial infections when fever was present. Fever is thought to contribute to host defense, as the reproduction of pathogens with strict temperature requirements can be hindered, and the rates of some important immunological reactions[clarification needed] are increased by temperature.Fever has been described in teaching texts as assisting the healing process in various ways, including: 1. 1.1. increased mobility of leukocytes;:1044[verification needed] 1.2. enhanced leukocyte phagocytosis;:1044[verification needed] 1.3. decreas...
Temperature is regulated in the hypothalamus. The trigger of a fever, called a pyrogen, results in the release of prostaglandin E2 (PGE2). PGE2 in turn acts on the hypothalamus, which creates a systemic response in the body, causing heat-generating effects to match a new higher temperature set point. Hence, the hypothalamus can be seen as working like a thermostat. When the set point is raised, the body increases its temperature through both active generation of heat and retention of heat. Pe...
A pyrogen is a substance that induces fever. In the presence of an infectious agent, such as bacteria, viruses, viroids, etc., the immune response of the body is to inhibit their growth and eliminate them. The most common pyrogens are endotoxins, which are lipopolysaccharides (LPS) produced by Gram-negative bacteria such as E. coli. But pyrogens include non-endotoxic substances (derived from microorganisms other than gram-negative-bacteria or from chemical substances) as well. The types of py...
PGE2 release comes from the arachidonic acid pathway. This pathway (as it relates to fever), is mediated by the enzymes phospholipase A2 (PLA2), cyclooxygenase-2 (COX-2), and prostaglandin E2 synthase. These enzymes ultimately mediate the synthesis and release of PGE2. PGE2 is the ultimate mediator of the febrile response. The set point temperature of the body will remain elevated until PGE2 is no longer present. PGE2 acts on neurons in the preoptic area (POA) through the pro...
Fever does not necessarily need to be treated, and most people with a fever recover without specific medical attention. Although it is unpleasant, fever rarely rises to a dangerous level even if untreated. Damage to the brain generally does not occur until temperatures reach 42 °C (107.6 °F), and it is rare for an untreated fever to exceed 40.6 °C (105 °F). Treating fever in people with sepsisdoes not affect outcomes.
Fever is one of the most common medical signs. It is part of about 30% of healthcare visits by children, and occurs in up to 75% of adults who are seriously sick.About 5% of people who go to an emergency room have a fever.
A number of types of fever were known as early as 460 BC to 370 BC when Hippocrates was practicing medicine including that due to malaria (tertian or every 2 days and quartan or every 3 days).It also became clear around this time that fever was a symptom of disease rather than a disease in and of itself. Infections presenting with fever were a major source of mortality in humans for about 200,000 years. Until the late nineteenth century, approximately half of all humans died from infections before the age of fifteen.
Fever is often viewed with greater concern by parents and healthcare professionals than might be deserved, a phenomenon known as fever phobia, which is based in both caregiver's and parents' misconceptions about fever in children. Among them, many parents incorrectly believe that fever is a disease rather than a medical sign, that even low fevers are harmful, and that any temperature even briefly or slightly above the oversimplified "normal" number marked on a thermometer is a clinically significant fever. They are also afraid of harmless side effects like febrile seizures and dramatically overestimate the likelihood of permanent damage from typical fevers. The underlying problem, according to professor of pediatrics Barton D. Schmitt, is "as parents we tend to suspect that our children’s brains may melt."As a result of these misconceptions parents are anxious, give the child fever-reducing medicine when the temperature is technically normal or only slightly elevated, and interfere...
Fever is an important feature for the diagnosis of disease in domestic animals. The body temperature of animals, which is taken rectally, is different from one species to another. For example, a horse is said to have a fever above 101 °F (38.3 °C). In species that allow the body to have a wide range of "normal" temperatures, such as camels, it is sometimes difficult to determine a febrile stage. Fever can also be behaviorally induced by invertebrates that do not have immune-system based fever. For instance, some species of grasshopper will thermoregulate to achieve body temperatures that are 2–5 °C higher than normal in order to inhibit the growth of fungal pathogens such as Beauveria bassiana and Metarhizium acridum. Honeybee colonies are also able to induce a fever in response to a fungal parasite Ascosphaera apis.
George Gordon Byron, 6th Baron Byron, FRS (22 January 1788 – 19 April 1824), known simply as Lord Byron, was an English peer who was a poet and politician. One of the leading figures of the Romantic movement, Byron is regarded as one of the greatest English poets.