Sepsis

1. Clinical Presentations

1.1. Tachycardia in early shock, may present normal to increased CO.

1.2. Temperature fluctuations, hyperthermia to hypothermia

1.3. effects of MODS, ARDS, DIC, mental status change, jaundice and clotting abnormalities

2. Risk-factors

2.1. Age increases incidences and mortality rates

2.2. Greater number of comorbidities

2.3. severe presentation of diseases, and impaired health functional status

3. Pathophysiology

3.1. Proinflammatory and antiinflammatory mechanisms become activated

3.2. Macrophages, IL-1, TNF-a and Nitric oxide cause SIRS reactions (fever, tahcycardia, leukocytosis = sepsis

3.3. Vasodilation, low BP, tissue inflammation, amd hypoperfusion become imminent. Finally, myocardial involvement with worsening hypoperfusion leads to MODS

4. Epidemiology

4.1. Of the estimated deaths from 2004-2009, 168,000–381,000 were noted.

4.2. 49% were aged 65–84 years

4.3. 26% were aged ≥85 year

5. Diagnosis: the recognition of the early symptoms of sepsis. Serum lactate, C-reactive protein and troponin. In older patients -withdrawal and agitation, absence of fever and sepsis-induced hypothermia may be present.

6. Treatments: IV fluids and vasopressors, with oxygen therapy and mechanical ventilation. Antibiotics for presence of infection.