Wikipedia:VideoWiki/Sepsis

Sepsis is a life-threatening condition, that arises when the body's response to infection causes injury to its own tissues and organs.{{cite journal | vauthors = Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC | display-authors = 6 | title = The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) | journal = JAMA | volume = 315 | issue = 8 | pages = 801–10 | date = February 2016 | pmid = 26903338 | pmc = 4968574 | doi = 10.1001/jama.2016.0287 }}

{{clear}}

Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.

File:Systemic inflammatory response syndrome.png

{{clear}}

There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection.

File:Chest radiograph in influensa and H influenzae, posteroanterior, annotated.jpg

{{clear}}

In the very young, old, and people with a weakened immune systems, there may be no symptoms of a specific infection. The body temperature can also be low or normal, rather than high.{{cite book |last= Jui |first= Jonathan |chapter= Ch. 146: Septic Shock |editor-last1= Tintinalli |editor-first1= Judith E. |editor-last2= Stapczynski |editor-first2= J. Stephan |editor-last4= Cline |editor-first4= David M. |editor-last3= Ma |editor-first3= O. John |editor-last5= Cydulka |editor-first5= Rita K. |editor-last6= Meckler |editor-first6= Garth D. | collaboration = American College of Emergency Physicians |title= Tintinalli's Emergency Medicine: A Comprehensive Study Guide |edition= 7th |location= New York |publisher= McGraw-Hill |pages= 1003–14 |year= 2011 |chapter-url= http://www.accessmedicine.com/content.aspx?aID=6364928 |url= http://accessmedicine.mhmedical.com/book.aspx?bookid=348 |access-date= 11 December 2012 |via= AccessMedicine |url-access=subscription |url-status= live |archive-url= https://web.archive.org/web/20140115051817/http://accessmedicine.mhmedical.com/book.aspx?bookID=348 |archive-date= 15 January 2014 }}

File:Khmerchildren.jpg

{{clear}}

Severe sepsis, is sepsis that is causing poor organ function, or insufficient blood flow to the body. Insufficient blood flow can manifest as either low blood pressure, high blood lactate, or low urine output.

File:Sepsis-Mikrothomben2.JPG

{{clear}}

Septic shock is low blood pressure due to sepsis, that does not improve after fluid replacement.{{cite journal | vauthors = Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R | display-authors = 6 | title = Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012 | journal = Critical Care Medicine | volume = 41 | issue = 2 | pages = 580–637 | date = February 2013 | pmid = 23353941 | doi = 10.1097/CCM.0b013e31827e83af | url = http://www.sccm.org/Documents/SSC-Guidelines.pdf | archive-url = https://web.archive.org/web/20150202150238/http://www.sccm.org/Documents/SSC-Guidelines.pdf | url-status = dead | archive-date = 2 February 2015 }}

File:Blood Pressure - Take Another Person.png

{{clear}}

Sepsis is caused by an inflammatory immune response, triggered by an infection.{{cite journal | vauthors = Deutschman CS, Tracey KJ | title = Sepsis: current dogma and new perspectives | journal = Immunity | volume = 40 | issue = 4 | pages = 463–75 | date = April 2014 | pmid = 24745331 | doi = 10.1016/j.immuni.2014.04.001 }}

File:SEM blood cells.jpg

{{clear}}

Most commonly, the infection is bacterial, but it may also be fungal, viral, or protozoan. Common locations for the primary infection include the lungs, brain, urinary tract, skin, and abdominal organs.

File:Collapsed tree labels simplified.png

{{clear}}

Risk factors include very young age, older age, and a weakened immune system from conditions such as cancer, diabetes, major trauma, or burns.{{cite web |title= Sepsis Questions and Answers |url= https://www.cdc.gov/sepsis/basic/qa.html |website= cdc.gov |publisher= Centers for Disease Control and Prevention (CDC) |access-date= 28 November 2014 |date= 22 May 2014 |url-status= live |archive-url= https://web.archive.org/web/20141204083832/http://www.cdc.gov/sepsis/basic/qa.html |archive-date= 4 December 2014 }}

File:Caring for Others.jpg

{{clear}}

An older method of diagnosis was based on the patient meeting at least two criteria from the systemic inflammatory response syndrome (called SIRS), because of a presumed infection.

File:Sepsis Steps.png

{{clear}}

In 2016, SIRS was replaced with a shortened sequential organ failure assessment score (called the SOFA score). With the quick SOFA, if the patient has any two of, increased breathing rate, change in their level of consciousness, or low blood pressure, then they meet the criteria.

File:Quick_sofa_score_graphic.png

{{clear}}

Blood cultures are recommended, preferably, before antibiotics are started, however, proof of infection in the blood is not required for the diagnosis.

File:Bloodculturetubes.JPG

{{clear}}

Medical imaging should be used to look for the possible location of infection.

File:Leberabszess - CT axial PV.jpg

{{clear}}

Other potential causes of similar signs and symptoms include, anaphylaxis, adrenal insufficiency, low blood volume, heart failure, and pulmonary embolism.

File:Angioedema2010.JPG

{{clear}}

Sepsis is usually treated with intravenous fluids, and antibiotics.{{cite journal | vauthors = Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP | display-authors = 6 | title = Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 | journal = Intensive Care Medicine | volume = 43 | issue = 3 | pages = 304–377 | date = March 2017 | pmid = 28101605 | doi = 10.1097/CCM.0000000000002255 |doi-access=free}}

File:Infuuszakjes.jpg

{{clear}}

Typically, antibiotics are given as soon as possible, with high level care such as in an intensive care unit.

File:Respiratory therapist.jpg

{{clear}}

If fluid replacement is not enough to maintain blood pressure, medications that raise blood pressure may be used. Mechanical ventilation and dialysis may be needed, to support the function of the lungs and kidneys.

File:Patient receiving dialysis 03.jpg

{{clear}}

To guide treatment, a central venous catheter, and an arterial catheter may be placed for access to the bloodstream. Other measurements such as cardiac output, and superior vena cava oxygen saturation may be used.

File:Blausen 0181 Catheter CentralVenousAccessDevice NonTunneled.png

{{clear}}

People with sepsis need preventive measures for deep vein thrombosis, stress ulcers and pressure ulcers, unless other conditions prevent such interventions. Some might benefit from tight control of blood sugar levels with insulin.

File:Blausen 0290 DeepVeinThrombosis.png

{{clear}}

The use of corticosteroids is controversial.{{cite journal | vauthors = Patel GP, Balk RA | title = Systemic steroids in severe sepsis and septic shock | journal = American Journal of Respiratory and Critical Care Medicine | volume = 185 | issue = 2 | pages = 133–9 | date = January 2012 | pmid = 21680949 | doi = 10.1164/rccm.201011-1897CI }} Although, a 2015 Cochrane review found low-quality evidence of benefit,{{cite journal | vauthors = Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y | title = Corticosteroids for treating sepsis | journal = The Cochrane Database of Systematic Reviews | volume = 12 | issue = 12 | pages = CD002243 | date = December 2015 | pmid = 26633262 | doi = 10.1002/14651858.CD002243.pub3 }} as did a 2019 review in JAMA.{{cite journal |last1=Fang |first1=F |last2=Zhang |first2=Y |last3=Tang |first3=J |last4=Lunsford |first4=LD |last5=Li |first5=T |last6=Tang |first6=R |last7=He |first7=J |last8=Xu |first8=P |last9=Faramand |first9=A |last10=Xu |first10=J |last11=You |first11=C |title=Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis: A Systematic Review and Meta-analysis. |journal=JAMA Internal Medicine |volume=179 |issue=2 |pages=213–223 |date=21 December 2018 |doi=10.1001/jamainternmed.2018.5849 |pmid=30575845}}

File:Depo-Medrol (Methylprednisolone Acetate injectable suspension, USP).jpg

{{clear}}

Disease severity partly determines the outcome. The risk of death from sepsis is as high as 30%, from severe sepsis as high as 50%, and from septic shock as high as 80%.{{cite journal | vauthors = Jawad I, Lukšić I, Rafnsson SB | title = Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality | journal = Journal of Global Health | volume = 2 | issue = 1 | pages = 010404 | date = June 2012 | pmid = 23198133 | pmc = 3484761 | doi = 10.7189/jogh.01.010404 }}

File:Sepsis mortality.png

{{clear}}

Millions are affected by sepsis each year, with a rate of 0.2-3 people per thousand, per year in the developed world{{cite journal | vauthors = Martin GS | title = Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes | journal = Expert Review of Anti-Infective Therapy | volume = 10 | issue = 6 | pages = 701–6 | date = June 2012 | pmid = 22734959 | pmc = 3488423 | doi = 10.1586/eri.12.50 }}. But the global burden of disease is unknown since little data exists from the developing world.

File:Death rate world map.PNG

{{clear}}

It is believed that rates of disease have been increasing, and that sepsis is more common among males than females.

File:Jehangir Hospital Building.jpg

{{clear}}

The medical condition has been described since the time of Hippocrates. The terms "septicemia" and "blood poisoning" have been used in various ways, and are no longer recommended.{{cite journal | vauthors = Angus DC, van der Poll T | title = Severe sepsis and septic shock | journal = The New England Journal of Medicine | volume = 369 | issue = 9 | pages = 840–51 | date = August 2013 | pmid = 23984731 | doi = 10.1056/NEJMra1208623}}

• {{cite web |author=Sara Fazio |date=30 August 2013 |title=Severe Sepsis and Septic Shock |website=The New England Journal of Medicine |url=http://blogs.nejm.org/now/index.php/severe-sepsis-and-septic-shock/2013/08/30/ |archive-url=https://web.archive.org/web/20130905234716/http://blogs.nejm.org/now/index.php/severe-sepsis-and-septic-shock/2013/08/30/ |archive-date=2013-09-05}}{{cite journal | vauthors = Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ | display-authors = 6 | title = Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine | journal = Chest | volume = 101 | issue = 6 | pages = 1644–55 | date = June 1992 | pmid = 1303622 | doi = 10.1378/chest.101.6.1644 | quote = Septicemia... has been used... in a variety of ways... We therefore suggest that this term be eliminated from current usage. | url = http://www.reanimatology.com/rmt/article/view/1584 }}

File:'ware Hitler's Greatest Ally Art.IWMPST14196.jpg

{{clear}}

{{RefList}}