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Causes and symptoms
sepsisInfectious disease Sepsis is defined by clinical parameters as 'SIRS–systemic inflammatory response syndrome plus a documented–ie, 'culture-positive' infection', and is part of a continuum of an inflammatory response to infection that evolves toward septic shock Clinical Tachypnea, tachycardia, hyperthermia, hypothermia Management Ibuprofen ↓ prostacyclin, thromboxane, ↓ tachycardia, fever, O2 consumption, lactic acidosis; NSAIDs do not prevent shock, ARDS, or improve survival. See Postanginal sepsis, Septic shock, Severe sepsis, SIRS.
sep·sis, pl. sepses (sep'sis, -sēz)
sepsisThe condition associated with the presence in the body tissues or the blood of micro-organisms that cause infection or of the toxins produced by such organisms. Sepsis varies in severity from a purely local problem to an overwhelming and fatal bacterial intoxication. Sepsis has been defined as the systemic inflammatory response to infection based on the clinical criteria of a temperature over 38 C, a heart rate of over 90 beats per minute, a respiratory rate of over 20 per minute and a white blood cell count increase of more than 12,000 or with more than 10 per cent immature neutrophil polymorphs. Severe sepsis is defined as sepsis associated with organ dysfunction. Severe sepsis has a mortality of up to 50 per cent.
sepsispresence of pus/pus-forming pathogenic organisms/their toxins in blood or tissue; characterized by a portal of entry (e.g. break in skin integrity) and increasing symptoms as sepsis worsens, i.e. marked inflammation, acute tenderness (patient 'guards' infected area, unless there is sensory neuropathy), lymphangitis (of lymphatic vessels draining infected tissues), regional lymphadenopathy (see lymphadenitis), suppuration, pus and abscess formation, general malaise and pyrexia; treatment depends on the degree of infection, local and limb tissue status, host response to infection, and nature of infecting organism; resolution of infection due to e.g. presence of a foreign body/ingrowing toe nail/paronychia/corn is usually achieved by removal of the artefact (allowing free drainage of any pus) together with appropriate dressing, and review (Table 1); more extensive infection (e.g. cellulitis; lymphangitis; lymphadenitis) or localized infection in an 'at-risk' patient should be considered for systemic antibiosis
|O||Operate||Remove the cause of the infection where possible, e.g. remove focal hyperkeratosis/foreign body/nail spike|
|C||Cleanse||Irrigate area/cleanse cavity with Warmasol delivered under pressure from a sterile syringe|
|H||Heat||Assist drainage of pus/exudate by applying heat, e.g. immersion in a warm hypertonic NaCl bath|
|A||Antiseptic||Apply a liquid or powder antiseptic (e.g. Betadine)|
|D||Dress||Cover the lesion with a sterile dressing (e.g. sterile gauze; Lyofoam)|
|R||Rest||Impose rest, e.g. deflective padding; shoe modification; walking cast; crutches, as necessary|
|A||Reappoint||Arrange to review case in 24-72 hours|
|R||Review||At the subsequent appointment, review progress|
If resolution has been initiated, continue to treat as above (O-A) and review weekly until healing is complete
If the infection has not improved, arrange for antibiosis, and continue to review and dress until healing is complete
|R||Refer||Refer for specialist review via GP: remember, slow-to-resolve infection can characterize undiagnosed diabetes, or other 'at-risk' patient category|
Use all normal preoperative procedures; keep infected lesions covered until ready to treat; take a swab for pathology laboratory analysis of any exudate; use a sterile dressings pack; follow the OCH-A-DRARR treatment mnemonic.
'At-risk' patients presenting with infection or patients presenting with acute or spreading infection should be treated using the OCH-A-DRARR protocol, but provided with or referred for immediate antibiosis.
sep·sis, pl. sepses (sep'sis, -sēz)
Patient discussion about sepsis
Q. What Is Sepsis? What does the term "sepsis" mean?