Response to foreign body

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Response to foreign body

• Inflammatory reaction
• Localized
• Generalized
• Generalized inflammatory reaction
• Infective
• Noninfective
• Sepsis Generalized inflammatory, having systemic
  signs

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Systemic Inflammatory Response Syndrome (SIRS)

• Patient presents with two or more of the
  following criteria.
• temperature gt 38C or lt 36C
• heart rate gt 90 beats/minute
• respiration gt 20/min or PaCO2 lt 32mm Hg
• leukocyte count gt 12,000/mm3, lt 4,000/mm3 or gt
  10 immature (band) cells

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Definition

• Sepsis SIRS plus a documented infection site
  (documented by positive culture for organisms
  from that site). Blood cultures do NOT need to be
  positive. While SIRS, sepsis, and septic shock
  are associated commonly with bacterial infection,
  bacteremia may not be present.
• Septic Shock Sepsis-induced hypotension despite
  fluid resuscitation
• PLUS hypoperfusion abnormalities

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Mechanism
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Organ Dysfunctions associated with Severe Sepsis
and Septic Shock
Lungs early fall in arterial PO2,
capillary-leakage into alveoli tachypnea,
hyperpnea (ARDS). Kidneys (acute renal
failure) oliguria, anuria, azotemia, proteinuria
Liver elevated levels of serum bilirubin,
alkaline phosphatase,cholestatic jaundice Heart
cardiac output is initially normal or elevated,
Brain confusion
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Organ Dysfunctions contd

• Digestive tract nausea, vomiting, diarrhea and
  ileus
• Skin ecthyma gangrenosum (think Pseudomonas
  aeruginosa in neutropenic patients),
• Petechia or purpura (think Neisseria
  meningitidis or
• Rickettsia rickettsia (if evidence of tick
  bite)), Hemorrhage or bullous lesions
• Toxic Shock Syndrome Staphylococcus aureus or
  Streptococcus pyogenes

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Complications
Adult respiratory distress syndrome (ARDS)
Disseminated Intravascular Coagulation (DIC)
Acute Renal failure (ARF) Intestinal bleeding
Liver failure Central Nervous system
dysfunction Heart failure Death
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When to suspect

• Fever or unexplained signs with malignancy or
  instrumentation
• Hypotension Oliguria or anuria
• Tachypnea or hyperpnea Hypothermia without
  obvious cause
• Bleeding
• High fever and bounding pulse, rigor, purpuric
  rash, tachypnoea

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THERAPY

• Immediate Stabilization of the Patient.
• The blood must be rapidly cleared of
  microorganisms
• The original focus of infection must be treated.

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