hey this is doctor kate my medical school today we're given update concepts
is talk about its definition it's diagnosis as well as a management sepsis
so what do sets as well such as it is a very profound inflammatory response
twin underlying infection
it leads to significant v so dilation so your vessels
dilate meaning to drop in blood pressure also because of inflammatory response
yoga pro-clinton stated in develops micro and a lot
that affect profusion of your organs
now we're talking about sets as we always have to mention serves serves as
the systemic
inflammatory response syndrome
heat you quite year to meet servers
and description include temperature less than ninety six point to the hypothermic
or greater than three point four
roster rate then twenty
or a p_c_ to less than thirty two
a white count less than four thousand
or greater than twelve thousand
you may also see aid being demian meaning greater than ten percent dancer
immature neutral fills
and finally a heartbreaker the ninety beats per minute so your service helps
identify
and underlying infection and plays a role the definition of sepsis so
let's have our definitions star start off with sets scl sepsis
if you need to service criteria
plus the presumed known sources servers pas presume known sources such as
the patients having this year european with urination
you can see you too yeah i at the ministers preaching collect sepsis
severe sepsis is a sexist picture
uh... product
they also have
organ hype a profusion so they could have
sepsis and he knows their kidney function is decreased at albany creat
or having trouble breathing that severe sepsis
now septic shock is sexes
but now
that shock is refractor
two fluids are you getting tons of food bowls is
the blood pressure is not coming up enemy texas criteria
that septic shock it support you know these because you will be pinned down
these definitions
now the treatments at his number one early recognition number two
antibiotics
and number three fluid resuscitation really important finally
source from whatever is causing infection
you removed from body or treat
now how do we recognize that is really what history of physical at the answer
and every question in medicine do a thorough history and physical when they
get sick
uh... any new exposures to handicap thursday thing like that
look at the vials
are at the do they have hypertension i detect a kartik
uh... unique search criteria
get elected to lactate measures your and organ perfusion
as will central venous option nation as cv you too
or two markers for an organ perfusion
but what help you identify a patient who is septic
father is a new marker called pro calcitonin
they were getting now eight is correlated with any significant
bacteremia civic because of bacteremia
the protest tom will be high indicate they have a high probability developing
sepsis
so it's a new mark or wheezing down the hospital something to think about when
you're working at her patients
who you believe have sepsis
injured and about x makes you could step anna maddox everyday late one outward
decreases survival by eight percent
to michigan appropriate animatic start why star broad he did not know the
source
and in the role
based on the culture data each of the food resuscitation your real goals and
full resuscitation of the for six hours or one
he cbp from eight to twelve
usually use crystallites button patients you can some patients please call though
it did not have a lot of the union on board
use normal saline or lack tutoring to map in sixty five
and finally you perceive you to grade seventy percent
at your central venous action saturation these three factors had been shown to
improve survival to increase your sense of peace action saturation one tool you
can use use
nitrous using r_t_c_'s
to increase your option carrying capacity now they suppresses if your
unable to she'd adequate tissue perfusion with food recess situation
star presses
so surviving sepsis campaigned recommended that really start with no
weapon afrin
and work your way up to act in africa day suppressant
but really there is no benefit to one of these over the other
one thing you may want to know is that that'll afrin
is preferred if northern afrin is causing packer witness now what do you
do you enforce esteem great in six hours your out your window
what you were be aware of too much fluid so they did a study that contributed to
that too much fluids
and in septic inbred sepsis compared to those who just got the right man fluids
and photo over what is going to poor outcome so watch
your patients action nations that is get translators to shut down
comedy maggie can you give us not be able to pull that flowed into
intravascular space
i would really diary sees patients in the peace first you couple hours they
are infected
pensions accord with steroids well does the court of this trial but then it does
show
galindo benefiting twenty-day mortality in terms of giving cortical steroids but
surviving sepsis campaign show that
those with some baseline adrenal insufficiency responded well to steroids
but surviving sepsis campaign says
if with the press is not working dentist in the chest and stare at you not need
to check today
uh... a c_t_ stimulation test to see if it ain't attitude insufficiency
september third line go to drug in terms of glucose is with as my sugar trial
said you want to keep your sugars less than one hundred eighty sure glucose
controls actually associate
with hypoglycaemia and worse outcomes
so now this brings us to use agresti activated protein c well it's something
we don't use any more
obs with withdrawn from the markets of ever comes up do not use agassi does not
improve morbidity mortality and it does increase your risk of bleeding
now let's say you're tryna trigger patients who still persists really sick
they're not getting better
where other things to think about the you can do
one always consider changing her antibiotics or add double covered for
pseudomonas
think about what other sources could be infected
they could be affected his patient to review assistance to the had back pain
could they have richie rosty my life that's contributing
to septic picture do they have the joint replacement of those infected
to really try to keep your car broad picture what's going on
and try really don't they don't buy this source
when your patient is precisely sick and definitely not getting back
always hillier antibiotics to your corporate data
it's will decrease not a food your patient gets
also will decrease exposure to come back
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