Wikipedia:VideoWiki/Sepsis

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Definition

Sepsis is a life-threatening condition, that arises when the body's response to infection causes injury to its own tissues and organs.[1]

Symptoms

Common signs and symptoms include

confusion.[2]

More specific symptoms

There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection.[3]

Young and old

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.[3]

Symptoms of severe sepsis

Severe sepsis, is sepsis that is causing

blood lactate, or low urine output.[4]

Septic shock

Septic shock is low blood pressure due to sepsis, that does not improve after fluid replacement.[4]

Causes

Sepsis is caused by an inflammatory immune response, triggered by an infection.[3][5]

Microbiology

Most commonly, the infection is

abdominal organs.[3]

Risk factors

Risk factors include very young age, older age, and a weakened immune system from conditions such as

diabetes, major trauma, or burns.[2]

Diagnosis

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.[3]

Modern diagnosis

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.[1]

Blood cultures

proof of infection in the blood is not required for the diagnosis.[3]

Medical imaging

Medical imaging should be used to look for the possible location of infection.[4]

Differential diagnosis

Other potential causes of similar signs and symptoms include, anaphylaxis, adrenal insufficiency, low blood volume, heart failure, and pulmonary embolism.[3]

Treatment

Sepsis is usually treated with

antibiotics.[2][6]

Antibiotics

Typically, antibiotics are given as soon as possible,[2] with high level care such as in an intensive care unit.[2]

Fluid replacement and blood pressure

If

raise blood pressure may be used.[2] Mechanical ventilation and dialysis may be needed, to support the function of the lungs and kidneys.[2]

Monitoring blood pressure

To guide treatment, a

arterial catheter may be placed for access to the bloodstream.[4] Other measurements such as cardiac output, and superior vena cava oxygen saturation may be used.[4]

Risks of sepsis

People with sepsis need preventive measures for

blood sugar levels with insulin.[4]

Steroid use

The use of

corticosteroids is controversial.[7] Although, a 2015 Cochrane review found low-quality evidence of benefit,[8] as did a 2019 review in JAMA.[9]

Prognosis

Disease severity partly determines the outcome.[10] 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%.[10]

Epidemiology

Millions are affected by sepsis each year, with a rate of 0.2-3 people per thousand, per year in the developed world

developing world[10]
.

Change in rate of disease

It is believed that rates of disease have been increasing[4], and that sepsis is more common among males than females.[3]

History

The medical condition has been described since the time of Hippocrates.[12] The terms "septicemia" and "blood poisoning" have been used in various ways, and are no longer recommended.[12][13]

References