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Transcript: SEPSIS Chelsea Byelick and Cassidy Houchins Sepsis is a toxic response to infection that kills 258,000 Americans each year. It is a medical emergency that requires early detection and treatment for survival. Learn more about the symptoms of sepsis.--->>> Patients usually experience a lot of dizziness and confusion With the fever, body temperature may appear normal. The body may also even feel like the temperature is too low The heart may beat very fast with low breathing Diagnosis Symptoms It is a leading cause of death in America, having 1 person die every 2.5 seconds. Sepsis can cause pain in the joints of the wrist, back, elbows, hips, knees, and ankles Statistic Fever Statistics More often than not, hospitalization is needed and antibiotics and therapy are needed to help the infected organs. Combinations of antibiotics are used to treat Sepsis, most using a combination of vancomycin. In addition to antibiotics, therapy to support the organs, which includes organ-system support or surgery, are required if they have been damaged. Surgery is needed to drain the organs and remove the source of infection from the body. It's important to look for the warning signs of sepsis. Spotting these symptoms early could prevent the body from entering septic shock, and could save a life. Statistic Sketches 1.2 per 1,000 hospitalized at risk patients developed post-operative sepsis in America What is Sepsis? They have dizziness, confusion, and can have a visible rash of red brown spots. Doctors can do blood work to test the bloods elevation of white blood cell counts. Taking a blood culture that is then sent to a lab to test for bacteria is also an option doctors have. Taking samples of body fluid (mucus, spinal fluid, ect.) can show the presence of infectious bacteria’s in the body. X-rays and CT scans of the organs can also show Doctors if the organs are under any negative impact. There is a 7% increase in mortality rate if antibiotics are delayed in severe cases of Sepsis. Treatment


Transcript: SeptiFast Master List Results What is Sepsis? Incorporation of both tests to enhance quality of diagnosis. "Perfecting" Multiplex PCR or creating new methods to reduce limitations. Eliminate blood culture analysis. Reduction of fatalities, hospital stay and cost, Who is Affected? Limitations of Multiplex PCR Lucignano B, Ranno S, Liesenfeld O, Pizzorno B, Putigani L, et al. (April 2011) Journal of Clinical Microbiology 49: 2252–2258. Limitations of Diagnosis: In the presence of SeptiFast, pathogens are always better identified Streptococcus spp. and Entercocci (contamination= not considered reliable results) PCR is has higher specificity. Blood Cultures have more contaminants. A life threatening complication of an infection. Infection -> release of infection-fighting chemicals -> inflammation organ failure death In vitro nucleic acid amplification with multiple templates and primers Gram-positive Gram-negative Fungi Used an internal control = exclude false negative Pathogen identification: Use SeptiFast master list Any human who has undergone: Severe trauma/burns Immunodeciencies Malignancies Premature births Multiplex PCR Allows Rapid and Accurate Diagnosis of Bloodstream Infections in Newborns and Children with Suspected Sepsis Samples Time dependent Rapid detection + prompt antimicrobial treatment Problems with previous methods (blood cultures) small sample size= low sensitivity for antibiotics low [pathogen] decreased accuract long incubation period= late detection high rate of contamination 811 subjects (0-18 yrs old) showing Systemic Inflammation Response Syndrome (SIRS) n= 1,673 blood samples Processed by: Blood culture LightCycler SeptiFast (Muliplex PCR) Methods and Materials Multiplex PCR is more effective than Blood Culture Sepsis Inoculated samples with Bactec broth medium(0.5-5 mL) Then, incubated for 8 days Pathogen identification: Gram staining Culture on solid medium Multiplex PCR Conclusions Future Implications Blood Cultures Detects DNA from dead microorganisms = false positives Mutation at target site = unable to amplify properly = low quality analysis Multiple primers= potential hybridization = potential mis-priming with other templates Contamination still possible

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Transcript: Stage II: Sepsis Infection accompanied by an acute inflammatory reaction with systemic manifestation associated with endogenous mediators Macrophage and Neutrophils release cytokine in to circulation to improve local response Leads to recruitment of macrophages and platelets Acute phase sepsis decrease pro inflammatory mediators by the release of endogenous antagonist Maintenance of any tubes and drains. - Check placement, patency, and output/input Ventilator care -Frequent assessments and monitoring Prophylactic care -Pressure ulcers and deep vein thrombosis Two or more of the following Temperature of > 38 C or < 36 C Heart Rate of > 90 Respiratory Rate of > 20 WBC count > 12 x 10 / L Andrew, Jimmy, Kara, Ryan, and Kat Systemic inflammatory response syndrome (SIRS) Sepsis summed up is: Sepsis associated with organ dysfunction, hypoperfusion, or hypotension. Examples: Signs of kidney hypoperfusion: oliguria Signs of brain hypoperfusion: ALOC Genitourinary The renal system is extremely sensitive to ischemic-perfusion injury; hypoperfusion can lead to Acute Renal Failure Oliguria Anuria Elevated Creatinine Metabolic Acidosis Increased Lactate Decreased Lactate Clearance Acute Tubular Necrosis A systemic inflammatory response in the presence of an infection... Pathophysiology Pathophysiology Stress ulcer prophylaxis: using histamine antagonists blockers or proton pump inhibitors. DVT prophylaxis Improve patients overall nutritional status, enhance immune function, and promote wound healing = daily caloric intake of 25 – 30 kcal/kg of usual body weight. Enteral route preferred. Management and treatment of specific organ failure. Stage I: SIRS Fibrin Deposition Platelet aggregation Coagulopathies Leukocyte liposomal Activation of pathway to increase inflammation by recruitment of neutrophils and monocytes. The inflammation to the endotoxin that Gram – negative bacteria release activates cytokine. Infection Finding and eradicating the cause of infection At least 2 blood culture plus urine, sputum, and wound culture Antibiotic therapy started within 1 hr of recognition Specific source of infection should be established within 6 hours. Sepsis induced multiple organ failure or a clinical determination of high risk for death = administration of recombinant human activated protein C or Xigris (drotrecogin alfa [activated]) IV at an infusion rate of 24 mcg/kg/hr for duration of 96 hours. Pathophysiology Hepatic Posttraumatic Hepatic Insufficiency Jaundice (Hyperbilirubinemia) Increased Liver Enzymes (AST and ALT) Decreased Albumin Gastrointestinal Bacterial Translocation Endogenous Endotoxemia Low perfusion or hypoxia can cause ischemic necrosis of the GI tract Ronga Stage III: Severe Sepsis Sepsis associated with organ dysfunction, hypoperfusion, hypotension 3 conditions: known or suspected infection, two or more clinical indications of systemic inflammatory response, and evidence of at least one organ dysfunction 2 most common organs to demonstrate dysfunction are cardiovascular and system and lungs Persistent hypotension requiring vasopressors: cardiovascular compromise Pulmonary dysfunction is manifested by PaO2/FIO2 ratio less than 300, indicated ALIPerfusion abnormalities such as lactic acidosis Two or more of the following Temperature of > 38 C or < 36 C Heart Rate of > 90 Respiratory Rate of > 20 WBC count > 12 x 10 / L Increase cellular oxygen supply & decrease cellular oxygen demand. Fluid resuscitation: increase intravascular volume and increase preload for CVP of 8-12 mm Hg. (Crystalloids of colloids) Fluid Challenge for hypovolemia with at least 1000 mL crytalloids or 300-500 mL of colloids over 30 minutes. Vasopressor administration: maintain a MAP of at least 65 mm Hg First choice agents: Norepinephrine or dopamine Alternate choice: Epinephrine Identifying Patients at Risk MODS results from progressive physiologic failure of two or more separate organ systems. It is defined as the “presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention” To understand MODS, you must first understand the continuum of sepsis. Extremes of age (<1 and > 65 years) Surgical/invasive procedures Malnutrition Patients on broad spectrum antibiotics Chronic illness/multiple co-morbidities Compromised immune status Malignancies Use of transplant/immunosuppressant drugs Increase in # of drug-resistant organisms SIRS with a present infection At-Risk Populations SIRS Systemic inflammatory response to a variety of severe clinical insults, manifested by two or more of the following conditions: Temperature >38 C or <36 C Heart rate >90 beats/min Respiratory rate >20 breaths/min or PaCO2 <32 mm Hg White blood cell count >12,000/mm3, <4000/mm3, or >10% immature band forms What is it?? Goal Directed Management Respiratory/Pulmonary The most commonly affected organs are the lungs, seen manifested as ALI and ARDS Patients with lung dysfunction are more critical Tachypnea with

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