SEPSIS PATHOPHIYSIOLOGY BUILDING BLOCKS OF KNOWLEDGE

SEPSIS KNOWLEDGE Sepsis is the body’s overwhelming response to infection…over active and toxic response to infection. It can be life threatening. It can lead to tissue damage, organ failure and death. 40% of patients diagnosed with severe sepsis DO NOT SURVIVE

SEPSIS KNOWLEDGE, con’t1 Sepsis begins with infection either gram – or gram + Gram staining is a special technique used to differentiate two large groups of bacteria based on their different cell wall makeup. Invented in 1884 by Hans Gram. This stain will either stain the cells purple (positive), or pink (negative). Gram + bacteria have a very thick cell wall made of a protein called peptidoglycan. These bacteria retain the crystal violet dye.

SEPSIS KNOWLEDGE, con’t2 Gram negative bacteria have a very thin peptidoglycan layer that is sandwiched between an inner cell membrane and a bacterial outer membrane. Gram negative bacteria do not retain the crystal violet stain and will stain pink. The difference between gram – and gram + will determine the treatment plan.

SEPSIS KNOWLEDGE, con’t3 When bacteria enter the bloodstream it is called bacteremia. As they travel the bloodstream, Gram negative bacteria releases endotoxins, or toxic by products of metabolism – toxic waste. Gram positive organisms release exotoxins. Exotoxins release toxic by products as well. These toxins cause the release of proinflammatory cytokins – these produce fever, inflammation and tissue destruction. Cytokins are an army of infection fighting forces, that mediate and regulate immunity, inflammation and hematopoiesis.

SEPSIS KNOWLEDGE, con’t4 These proinflammatory cytokins activate Complement system Coagulation system Kinin system Neutrophil,endothelial and macrophage cell activity These release anti-inflammatory cytokins

SEPSIS KNOWLEDGE, con’t5 The anti-inflammatory cytokines are a series of immunoregulatory molecules that control the pro-inflammatory cytokine response. A check and balance that spirals out of control, ultimately causing endothelial cell dysfunction. WHY????? This is SIRS… Systemic Inflammatory Response Syndrome.

SEPSIS KNOWLEDGE, con’t6 Endothelial cell dysfunction leads to: Capillary leak Microvascular thrombus Cell adhesion Tissue hypoxia Apoptosis (cell death) Impaired vascular tone Free radical damage (when free radicals cause damage to parts of cells, such as DNA & cell membranes, by stealing their electrons through a process called oxidation)

SEPSIS KNOWLEDGE, con’t7 Now we have septic shock leading to Multiple Organ Dysfunction Altered mental status Pulmonary function <300/Tachypnea Urine output <0.5ml/kg/hr Hypotension/Tachycardia Thrombocytopenia/Increased D-dimer Metabolic Acidosis/Increased Lactate Poor capillary refill

SEPSIS KNOWLEDGE, con’t8 EVENTUALLY, DEATH

SEPSIS KNOWLEDGE, con’t9 TIME TIME TIME TIME TIME TIME TIME TIME TIME TIME TIME TIME Beat The Clock Time is of essence Don’t Waste Time VERY EARLY TREATMENT Hurry Time Saves Lives Go Faster Suspect Sepsis React Quickly

SEPSIS KNOWLEDGE, con’t10 ASSESS FLUID ANTIBIOTICS VASOPRESSORS RE-ASSESS SYSTEM SUPPORT