1 Name : Lie Khie Chen Birth : Jakarta Graduates MD : FKUI 1994 Internist : FKUI 2003 Consultant : FKUI 2006 Occupation Internal Medicine Department Tropical Medicine and Infectious Diseases Division Interest Sepsis Antimicrobial Treatment Antimicrobial Resistance Fungal Infection HIV and opportunistic infections Curriculum Vitae Diagnostic and Risk Stratification in Severe Sepsis Khie Chen Tropical Medicine and Infectious Disease Division Internal Medicine Department Medical Faculty University of Indonesia Sepsis Clinical syndrome Host response to infection Systemic process Multi organ system affected
12
Embed
Curriculum Vitae - · PDF fileDefinisi Sepsis SCCM/ESICM/ACCP/ATS/SIS 2001 ... Hipotensi arterial (tekanan sistolik
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
Name : Lie Khie Chen
Birth : Jakarta
Graduates
MD : FKUI 1994
Internist : FKUI 2003
Consultant : FKUI 2006
Occupation
Internal Medicine Department
Tropical Medicine and Infectious Diseases Division
Interest
Sepsis
Antimicrobial Treatment
Antimicrobial Resistance
Fungal Infection
HIV and opportunistic infections
Curriculum Vitae
Diagnostic and Risk
Stratification in Severe Sepsis
Khie Chen
Tropical Medicine and Infectious Disease Division
Internal Medicine Department
Medical Faculty University of Indonesia
Sepsis
Clinical syndrome
Host response to infection
Systemic process
Multi organ system affected
2
The Sepsis Cascade Bacterial Product
And Component
TNF –a
IL-1
IL-6
PAF
NO
etc
Activation of Coagulation
And Complement
System
Tissue Factor Release
Fibrinolytic acitvity
T cell Release
Of IL-2
IFN gamma
GM-CSF
Metabolism of
Arachidonic Acid
Release of
Tromboxane A2
PGS, LTS
Neutrophyl
Activation
Agregation
Degranulation
Release of O2
Radical and
Proteases
Platelet
Activation
Aggregation
Endothelial Damage
Tissue Injury
Organ Dysfunction
Macrophage
Source : Medscape.com
Hemodynamic disturbance in Sepsis
1. Hypovolemic
2. Peripheral vasodilatation
3. Myocardial dysfunction
4. Maldistribution of blood volume
3
Systemic Inflammatory Response Syndrome (SIRS)
Host response to Inflammation include 2 of:
1. Temp >38oC or <36oC 2. Heart rate >90x/’ 3. Respiratory rate >20x/’ or PaCO2<32mmHg 4. White blood cells count >12.000/mm3, < 4.000 or bands >10%
Bone et al. Chest 1992;101:1644
SIRS and host response
Vincent JL. Sepsis : The magnitude of the problem. In : Vincent
JL, Carlet J, Opal S (eds). The sepsis text. Boston: Kluwer
Academic Publishers; 2002. p. 1-9.
Host Response in Sepsis
Compensated state :
Tachycardia
Tachypnea
Fever
Leucocytosis
Thrombocytosis,
Hyperglycemia
Increased acute phase
reactant
(CRP, procalcitonin,
LDH and albumin)
Decompensated state (Multiple organ dysfunction or failure) :
Decreased of consciousness, Hypothermia
Hypotension
Shock
Decreased PaO2
Increased serum creatinine, Oliguria
Anemia, leucopenia, thrombocytopenia and Coagulopathy.
Pohan HT, Med J Indones
4
ACCP/SCCM Consensus Conference Definitions ofSepsis, Severe Sepsis and Septic Shock