3rd year septicemia.pptx

septecaemia

1. septicemia Dr. Md. Nazmus Sakib Junior Consultant Department of Surgery Email- [email protected]

2. History Infection has always been a major complication related to surgery. Both Egyptians and Greeks independently described about the knowledge of infection. The Hippocratic teachings described the use of wine and vinegar to irrigate open or infected wound. A belief common to all civilizations was that whenever pus is localized it needs to be drained.

3. Hungarian obstetrician Ignaz Semmelweiss was the first to introduce the importance of antisepsis in Vienna in early 1850. He drastically reduced the mortality rate by introducing hand sanitization during child birth process. But medical community rejected his claims and accused him for high mortality rate. He was admitted to an insane asylum at 47 years age and he died two weeks later.

4. Koch’s postulate A specific organism can always be found in association with a given disease. The organism can be isolated and grown in pure culture in the laboratory. Pure culture will produce the disease when inoculated in susceptible animal. It is possible to recover the organism in pure culture in experimental animal. CONT…

5. Professor Sir Alexander Fleming a Scottish-born microbiologist discovered first antibiotic Penicillin in 1928 Penicillium notatum , the source of penicillin, the first antibiotic CONT…

6. Bacteramia : Presence of bacteria in blood which is evident by positive blood culture. Septicaemia: Bacteramia with presence of sign & symptom (of bacterial proliferation & toxin) is called septicaemia. Systemic inflammatory response syndrome (SIRS) is a systemic manifestation sepsis which may also be caused by trauma, burn or pancreatitis.

7. Sepsis: SIRS with documented infection is called sepsis. Severe sepsis or sepsis syndrome is sepsis with evidence of failure of one or more organs: respiratory (acute respiratory distress syndrome), cardiovascular (septic shock follows compromise of cardiac function and fall in peripheral vascular resistance), renal (usually acute tubular necrosis), hepatic, blood coagulation systems or central nervous system

8. Multiple organ dysfunction syndrome (MODS): when sepsis causes two or more organ dysfunction it is called MODS. Multiple system organ failure (MSOF): it is the end stage of uncontrolled MODS.

9. Systemic inflammatory response syndrome (SIRS) Presence of two out of three of the following: Hyperthermia (>38°C) or hypothermia (<36°C) Tachycardia (>90/min, no β- blockers) or tachypnoea (>20/min) White cell count >12 × 109/LITRE or <4 × 109/litre

10. The Sepsis Six is the name given to a bundle of medical therapies designed to reduce mortality in patients with sepsis. Drawn from international guidelines that emerged from the Surviving Sepsis Campaign, the Sepsis Six was developed by the UK’s Sepsis Trust. The components of the

11. Sepsis Six are: Give three to patients: Intravenous fluid challenge, Intravenous antibiotics, Oxygen and monitor urine output Take three from patients: (4) blood cultures, (5) full blood count, (6) lactate.

12. Cause From any sorts of septic foci when microorganism enters into blood stream and causes systemic manifestation. Microorganism- almost any germ can cause septicaemia but most commonly Staphyllococcus aureus Strepcoccus neumoniae E coli

13. Sepsis if not treated promptly may cause septic shock and MODS

14. Symptoms

15. Diagnosis Blood culture (confirmatory) Others Complete blood count C reactive protein Specific organ function test for detection of MODS (s creatinine , FDP, D dimer , CXR etc)

16. Management According to European Society of Intensive Care Medicine (ESICM) and Society of Critical Care Medicine (SCCM) start sepsis bundle (sepsis six) within 6 hours for patient presenting with Severe sepsis Septic shock S lactate > 4mmol/L

17. Last but not the least Removal of source of infection either by drainage or by debridement is the main concern Prevention of infection by prophylactic use of antibiotics If organ failure develops treat accordingly.

18. Antibiotic prophylaxis Not required in clean surgery unless a prosthesis is implanted Use antibiotics that are effective against expected pathogens Plan for single-shot intravenous administration at induction of anaesthesia Repeat only during long operations or if there is excessive blood loss Patients with heart valve disease or a prosthesis should be protected from bacteraemia

19. Thank you