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Sepsis, Septicaemia, Septic Shock

Source: www.mpaeds.org.my
Topic: Sepsis
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Sort Desciption: SEPSIS, SEPTIC ... children may develop community acquired sepsis. ... With progression to SEVERE SEPSIS, there are features of compromised ...

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Definitions (based on American College of Chest Physicians and Society of Critical Care Medicine consensus) SIRS (Systemic Inflammatory Response Syndrome) Non specific systemic inflammatory response to infection, trauma, burns, surgery etc. Characterised by 2 or more of the following: changes in body temperature heart rate respiratory function peripheral leucocyte count Sepsis SIRS due to infection. Characterised by features of SIRS AND clinical evidence of INFECTION Severe sepsis Sepsis associated with decreased end organ perfusion: respiratory hypoxaemia CNS altered sensorium renal oliguria metabolic lactic acidosis Septic shock Severe sepsis with haemodynamic and circulatory compromise i.e. hypotension (systolic blood pressure SBP drops below 5 th centile for age). Early septic shock (WARM shock) Compensated warm phase of shock. Prompt response to fluids and pharmacologic treatment. Refractory septic shock (COLD shock) Late decompensated phase. Shock lasting more than 1 hours despite vigorous therapy necessitating vasopressor support. Incidence Non hospitalized immunocompetent children may develop community acquired sepsis. More commonly, hospitalized immunocompromised patients are at higher risk of developing serious nosocomial sepsis. Pathophysiology Infection Activation of immunological system Release of inflammatory chemical mediators Systemic vasodilation Capillary leakage Intravascular volume depletion Maldistribution of intravascular volume Impaired myocardial function Clinical features Sepsis, severe sepsis and septic shock are a clinical continuum. SEPSIS is present when 2 or more of the following features are present Fever ( > 38.5 o C) or hypothermia often in neonate <36 o C Hyperventilation Tachycardia White blood count abnormalities: leukocytosis or leukopenia and there is clinical evidence of infection. Other constitutional symptoms poor feeding, diarrhea, vomiting, lethargy may be ...

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