Sepsis y Shock Séptico

Etiología y Fisiopatología

Etiología

• Puede ser adquirida en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la comunidad o nosocomial
• Fuente de infección:
  • Identificada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ⅓ de los LOS Neisseria pacientes
  • La más frecuente es la neumonía, seguida de las infecciones intraabdominales y genitourinarias
• Cultivos:
  • Hemocultivos: positivos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ⅓ de los LOS Neisseria pacientes
  • Es común obtener cultivos negativos de otros sitios
• Patógenos gram-positivos más comunes:
  • Staphylococcus aureus Staphylococcus aureus Potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and perineum of warm-blooded animals. They may cause a wide range of infections and intoxications. Brain Abscess
  • Streptococcus Streptococcus Streptococcus is one of the two medically important genera of gram-positive cocci, the other being Staphylococcus. Streptococci are identified as different species on blood agar on the basis of their hemolytic pattern and sensitivity to optochin and bacitracin. There are many pathogenic species of streptococci, including S. pyogenes, S. agalactiae, S. pneumoniae, and the viridans streptococci. Streptococcus pneumonia Pneumonia Pneumonia or pulmonary inflammation is an acute or chronic inflammation of lung tissue. Causes include infection with bacteria, viruses, or fungi. In more rare cases, pneumonia can also be caused through toxic triggers through inhalation of toxic substances, immunological processes, or in the course of radiotherapy. Pneumonia
• Patógenos gram-negativos más comunes:
  • Escherichia coli Escherichia coli The gram-negative bacterium Escherichia coli is a key component of the human gut microbiota. Most strains of E. coli are avirulent, but occasionally they escape the GI tract, infecting the urinary tract and other sites. Less common strains of E. coli are able to cause disease within the GI tract, most commonly presenting as abdominal pain and diarrhea. Escherichia coli
  • Klebsiella Klebsiella Klebsiella are encapsulated gram-negative, lactose-fermenting bacilli. They form pink colonies on MacConkey agar due to lactose fermentation. The main virulence factor is a polysaccharide capsule. Klebsiella pneumoniae is the most important pathogenic species. Klebsiella spp.
  • Pseudomonas aeruginosa Pseudomonas aeruginosa A species of gram-negative, aerobic, rod-shaped bacteria commonly isolated from clinical specimens (wound, burn, and urinary tract infections). It is also found widely distributed in soil and water. P. Aeruginosa is a major agent of nosocomial infection. Pseudomonas
• Hongos: identificados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una pequeña minoría de casos (alrededor del 3%–6% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum muchas cohortes)
• Virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology: solo se han reportado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 1% de los LOS Neisseria casos

Fisiopatología

La carga y virulencia del patógeno + la composición genética y comorbilidades del huésped dan lugar a una respuesta compleja, exagerada y prolongada del huésped a la infección que evoluciona con el tiempo.

1. Reconocimiento de patrones moleculares asociados a patógenos por parte de los LOS Neisseria receptores de reconocimiento de patógenos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células inmunitarias innatas → respuesta inflamatoria (e.g., liberación del factor de necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage tumoral) → daño tisular y muerte celular necrótica → liberación de patrones moleculares asociados a daños → mayor activación de los LOS Neisseria leucocitos → cambios microvasculares: (disfunción de las células endoteliales + activación de la coagulación y del complemento)
2. Cambios macrovasculares: vasodilatación e hipotensión
3. Cambios microvasculares + cambios macrovasculares → fuga vascular, edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema, depleción del volumen intravascular → deterioro de la oxigenación tisular, alteraciones celulares como mayor glucólisis (producción de lactato), lesión mitocondrial y liberación de especies de oxígeno → aumento del daño orgánico

Presentación Clínica

• Piel y pulsos periféricos:
  • Shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock séptico temprano con depleción de volumen: extremidades frías y presión de pulso estrecha que refleja un aumento de la resistencia vascular sistémica y una reducción del gasto cardíaco
  • Con la progresión del shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock: extremidades relativamente calientes y ampliación de la presión del pulso que refleja la reducción de la resistencia vascular sistémica y el aumento del gasto cardíaco
• Insuficiencia respiratoria:
  • Síntomas del síndrome de dificultad respiratoria aguda, incluyendo:
    • Taquipnea
    • Respiración superficial
    • Uso de músculos accesorios
    • Fatiga respiratoria con movimientos abdominales paradójicos
    • Crepitantes bilaterales
    • Hipoxia
    • Infiltrados pulmonares bilaterales no explicados por insuficiencia cardíaca
• Insuficiencia cardíaca:
  • Hipotensión
  • Taquicardia
  • Taquipnea
  • Crepitantes pulmonares secundarios al AL Amyloidosis edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema pulmonar
• Injuria renal aguda:
  • Disminución de la diuresis
  • Azotemia Azotemia A biochemical abnormality referring to an elevation of blood urea nitrogen and creatinine. Azotemia can be produced by kidney diseases or other extrarenal disorders. When azotemia becomes associated with a constellation of clinical signs, it is termed uremia. Acute Kidney Injury/ uremia Uremia A clinical syndrome associated with the retention of renal waste products or uremic toxins in the blood. It is usually the result of renal insufficiency. Most uremic toxins are end products of protein or nitrogen catabolism, such as urea or creatinine. Severe uremia can lead to multiple organ dysfunctions with a constellation of symptoms. Acute Kidney Injury
• Síntomas y complicaciones neurológicas:
  • Alteración del estado mental:
    • Delirium Delirium Delirium is a medical condition characterized by acute disturbances in attention and awareness. Symptoms may fluctuate during the course of a day and involve memory deficits and disorientation. Delirium
    • Coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma
  • Ausencia de lesiones focales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la imagenología
  • Encefalopatía global en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la electroencefalografía
  • Polineuropatía y miopatía por enfermedad crítica si la estancia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la unidad de cuidados intensivos (UCI) es especialmente prolongada
  • Deterioro cognitivo crónico de moderado a severo
• Otras características clínicas/de laboratorio y complicaciones:
  • Íleo
  • Elevación de las enzimas hepáticas
  • Coagulación intravascular diseminada
  • Insuficiencia suprarrenal
  • Síndrome del enfermo eutiroideo

Diagnóstico

Abordaje general

1. Sospechar sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cualquier paciente que presente cualquiera de los LOS Neisseria siguientes síntomas:
   • Infección sin disfunción orgánica aparente
   • Disfunción orgánica de nueva aparición e inexplicable sin infección aparente
   • Signos vitales anormales como fiebre, taquipnea, taquicardia o presión arterial baja
   • Alteración del estado mental
2. Aplicar herramientas de tamizaje: sirven como herramientas de identificación temprana y/o de estratificación de riesgo:
   • NEWS: National Early Warning Score
     • El nivel de evidencia más fuerte existe para la puntuación NEWS
     • Herramienta de tamizaje sensible en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la sala de emergencias, predice los LOS Neisseria resultados relacionados con la sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock
     • La puntuación se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la evaluación rápida de cabecera de frecuencia respiratoria, saturación de O2, necesidad de O2 suplementario, temperatura, presión arterial sistólica, frecuencia cardíaca y nivel de consciencia.
   • MEWS: Modified Early Warning Score es similar a la puntuación NEWS, pero el uso de O2 suplementario no se tiene en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cuenta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la puntuación.
   • SOFA SOFA Sepsis and Septic Shock: Sequential Organ Failure Assessment Sequential Organ Failure Assessment Sepsis in Children
     • Predice el riesgo de mortalidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos con sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock
     • Diseñado para evaluar la mortalidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum poblaciones, pero no es tan útil para determinar el riesgo individual
   • qSOFA qSOFA Presence of 2 of the following 3 criteria indicates a worse outcome in a patient suspected of having sepsis and triggers an immediate diagnostic workup and treatment as appropriate. Sbp < 100 mm hg, respiratory rate > 22/min, altered mental status. Types of Shock: quick Sequential Organ Failure Assessment Sequential Organ Failure Assessment Sepsis in Children (evaluación rápida del fallo orgánico)
     • Ya no se recomienda como única herramienta de tamizaje de la sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock
     • Es útil para predecir mal pronóstico (curso prolongado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la UCI y muerte)
   • SIRS: Síndrome de respuesta inflamatoria sistémica (por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés)
     • Ya no se recomienda como única herramienta de tamizaje para la sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock
     • Depende de los LOS Neisseria resultados de laboratorio, lo que retrasa el diagnóstico (inadecuado para el triaje)
     • Los LOS Neisseria criterios pueden cumplirse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum afecciones no relacionadas con infecciones
3. Procedimientos operativos estándar para la sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock: iniciar intervenciones tempranas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum individuos con riesgo moderado-alto de sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock basadas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum herramientas de tamizaje (anteriormente conocidas como terapia temprana dirigida a objetivos)
4. Iniciar el paquete de medidas de la hora 1 (véase “Tratamiento”): vigilar estrechamente la respuesta a las intervenciones y los LOS Neisseria criterios de shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock séptico.

Criterios diagnósticos

• Criterios de sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock:
  • Infección sospechada (o documentada)
  • Aumento de ≥ 2 puntos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la escala SOFA SOFA Sepsis and Septic Shock
• Criterios de shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock séptico:
  • Infección sospechada (o documentada)
  • Necesidad de terapia con vasopresores para mantener una presión arterial media (PAM) ≥ 65 mm Hg a pesar de la administración adecuada de cristaloides por vía intravenosa
  • Lactato sérico > 2,0 mmol/L a pesar de la administración adecuada de cristaloides intravenosos
• qSOFA qSOFA Presence of 2 of the following 3 criteria indicates a worse outcome in a patient suspected of having sepsis and triggers an immediate diagnostic workup and treatment as appropriate. Sbp < 100 mm hg, respiratory rate > 22/min, altered mental status. Types of Shock:
  • Una sencilla herramienta a la cabecera del paciente para su uso fuera de la UCI y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el entorno preclínico:
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con sospecha de infección: tener ≥ 2 de los LOS Neisseria 3 criterios siguientes indica malos resultados (curso prolongado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la UCI y muerte) y requiere de una investigación más profunda, monitorización frecuente, una intensificación del tratamiento y el ingreso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la UCI, según proceda
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes sin sospecha previa de infección: desencadena la consideración de una infección
  • Criterios:
    • Presión arterial sistólica < 100 mm Hg
    • Frecuencia respiratoria ≥ 22/min
    • Alteraciones mentales
• Síndrome de respuesta inflamatoria sistémica (SIRS): ya no se utiliza para el diagnóstico de la sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock

Tratamiento

¡La sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock y el shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock séptico son emergencias médicas!

Soporte respiratorio

• Indicaciones de intubación endotraqueal y soporte ventilatorio mecánico:
  • Hipoxemia significativa (PaO₂ < 60 mm Hg o saturación de oxígeno < 90%)
  • Hipoventilación (aumento de la PCO₂)
  • Alteración significativa del nivel de conciencia
  • Incapacidad de proteger la vía aérea con riesgo de aspiración
  • Acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis metabólica persistente con pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance < 7,20
• Objetivo: saturación arterial de oxígeno del 92%–95%

Paquete medidas de la hora 1

El paquete de medidas de la hora 1 incita a los LOS Neisseria médicos a actuar lo más rápidamente posible. Idealmente, los LOS Neisseria siguientes pasos se inician en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la 1ra hora tras el diagnóstico de sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock.

1. Monitorizar el nivel de lactato sérico (volver a medirlo si es > 2 mmol/L).
2. Obtener hemocultivos (positivos solo en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 30% de los LOS Neisseria pacientes con presunta sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock) antes de iniciar los LOS Neisseria antibióticos.
3. Inicie los LOS Neisseria antibióticos de amplio espectro.
4. Cristaloides intravenosos: administrar rápidamente (30 mL/kg) si hay hipotensión (presión arterial media < 65 mm Hg) y/o lactato ≥ 4 mmol/L.
5. Vasopresores:
   • Administrar si hay hipotensión durante o después de la reanimación con cristaloides intravenosos.
   • 1ra opción: norepinefrina, más vasopresina para aumentar la presión arterial media y reducir el uso de norepinefrina

Monitoreo

• Análisis del contorno del pulso arterial
• Ultrasonido cardíaco focalizado (gasto cardíaco, volumen sistólico latido a latido y variación de la presión del pulso)
• Maniobra de elevación pasiva de las piernas
• Colapsabilidad de la vena cava inferior en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el ultrasonido

Glucocorticoides

• No deben utilizarse de forma rutinaria
• Se ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia demostrado que la dexametasona reduce la mortalidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con enfermedad por coronavirus Coronavirus Coronaviruses are a group of related viruses that contain positive-sense, single-stranded RNA. Coronavirus derives its name from “κορώνη korṓnē” in Greek, which translates as “crown,” after the small club-shaped proteins visible as a ring around the viral envelope in electron micrographs. Coronavirus 2019 ( COVID-19 COVID-19 Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that mainly affects the respiratory system but can also cause damage to other body systems (cardiovascular, gastrointestinal, renal, and central nervous systems). , por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés) que reciben soporte respiratorio.
• Recomendación débil: iniciar hidrocortisona intravenosa si el shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock séptico no responde a líquidos ni a los LOS Neisseria vasopresores.
• Omitir los LOS Neisseria esteroides si los LOS Neisseria vasopresores dejan de ser necesarios.

Medidas adicionales

• Transfusión de eritrocitos: solo se recomienda si la hemoglobina es < 7 g/dL
• Tratamiento con insulina: se recomienda un objetivo de glucosa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum sangre de 140–180 mg/dL (7,7 a 10 mmol/L).
• Profilaxis de trombosis venosa profunda: heparina no fraccionada a dosis bajas o heparina de bajo peso molecular (HBPM) si no existen contraindicaciones, como una hemorragia activa o una trombocitopenia importante
• Monitorización y tratamiento estrecho de las anomalías electrolíticas
• Soporte nutricional: se prefiere la vía enteral.
• Comunicar eficazmente el estado de la sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock durante los LOS Neisseria cambios de turno.