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A snapshot of the summary - Physiology advanced concepts
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1 Sepsis
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1.1 College 1
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What is a septic shock?Uncontrolled response of the body to severe infection (sepsis), together with the need for medications to normalize blood pressure and normalize other values.
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Where does sepsis start?Can start in every organ, depends where infection starts
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Which receptors are pretty important for the development of sepsis?
Toll like receptors -
How does the pathway via the TLR leads to sepsis?TLR activate production of cytokines -> recruit immune cells to the site of infection (which is a good thing, but when the response is too much a sepsis develops). Normally the reaction of the body is locally, but in the case of sepsis there is an uncontrolled amplification of the immune response throughout the whole body
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How is the severity of sepsis determined?By the SOFA score (3 categories, for each you can give 1 point when the patients meets the requirement). If the score is 2 or higher then the patient has a severe sepsis (admitted to ICU)
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What happens during a septic shock?There is decreased oxygen delivery to the tissues and this may lead to hypotension and eventually to organs that are not able to perform their normal function (organ failure).
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What is important when a patient is very sick?Administer broad-spectrum antibiotics within the hour. For patients that are less sick, you can wait till you have cultured samples to be more specific.
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Which drugs are often used to treat sepsis?1.
Norepineprhine
2. Vasopressin (ADH) (used in combination with 1)
3. Dobutamine
4. Mihinone
5. Phenylephrine -
How does norepinephrine work? 1.Norepineprhine
-->increases BP andSVR (alpha 1receptors on blood vessels)
--> protects blood flow to organs (beta 2receptors on bv)
-->increases HR and CO (beta 1receptors on heart)
This improves the delivery of oxygen -
How does vasopressin (ADH) works?2. Vasopressin (ADH) (used in combination with 1)
--> increases SVR and BP; increases volume (V1 receptors on bv)
--> increases H20O reabsorption and therefore increase of BP (V2 receptors kidney)
--> may lead to ischemic toes and fingers because tightening of blood vessels is too much
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