Title: Early and Innovative Interventions for Severe Sepsis and Septic Shock: Taking Advantage of A Window of Opportunity
Authors: Rivers E, McIntyre L, Morro D, Rivers K
Source: Canadian Medical Association Journal October 25 2005; pages 1054-1065
PODIATRIC RELEVANCE:
As foot and ankle specialists we should be able to identify a severely infected patient that has the potential to become septic. It is impartive to understand the logical steps and methods of treating this serious and complex patient.
METHODS:
This is a review article that emphasizes the importance of early recognition, diagnosis and therapeutic management of sepsis. Patients may arrive to the Emergency Department with a relatively benign or clinically unapparent infection that within hours may progress to sepsis. One way to access this is by understanding the manifestations of systemic inflammatory response syndrome (SIRS), it should be noted that these criteria that follow are non-specific for sepsis. SIRS includes two or more of the following: temperature >38 degrees Celsius or < 36 degrees Celsius, heart rate >90 beats/min (unless patient is on beta-blocker or calcium-channel blockers or heart is paced), respiratory rate > 20 breaths/min, and/or leukocyte count > 12,000 or < 4,000, or immature band >10%. The second step in diagnosing sepsis is if there is a source of infection present. Severe sepsis occurs when organs are hypoperfused, which leads to increase blood lactate levels (> 4.0), oliguria, poor capillary refill, and acute mental status changes. Dysfunction of one or more organs may present as thrombocytopenia, disseminated intravascular coagulation, acute respiratory distress syndrome, acute real failure delirium, etc.
Treatment should be implemented within six hours of diagnoses. Treatment should consist of early antimicrobial therapy and surgical control of infection, early hemodynamic optimization, hemodynamic monitoring, volume therapy, vasoactive agents, administration of erythrocytes, inotropic therapy, and decreasing oxygen consumption are all important to initiated in six hours.
COMMENTS:
As foot and ankle surgeons treating diabetic patients, we need to be able to evaluate and treat severe foot infections on a multi-factorial level.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.