Definition of Sepsis

00:01 How do you define sepsis? SIRS plus a source of infection.

00:05 Okay. SIRS plus a known source of infection is sepsis. How do you define septic shock? Yeah. What's the word you're looking for? Refractory hypertension, is refractory to fluid resuscitation.

00:29 So you can have a patient with shock, but then if you give them fluids, they become normovolemic or normotensive. But in a patient with septic shock, peripheral vasodilatation, pooling in the peripheries, so even if you give fluids, they're not going to respond. So that is septic shock. So that's the difference between shock and septic shock.

00:55 I have a question. No. Not at all. Frequently what happens is, somebody sustains a burn at say 12 midnight, by the time you see them it's four o'clock, 4 a.m. So by 8 a.m., you should have given the first half of the fluid. Clearly, you can’t, because you got only four hours to catch up. So what we tell you, what we normally do, is try to titrate whatever you can give in these four hours, and then catch it up in the next couple of hours. Okay? So you have to be a bit careful of pushing so much of fluid just because you have to stick to the guideline.

01:53 You can of course, you can give a couple of litres of Hartmann’s as a bolus. But you have to be careful. The more fluid you push in, you increase the hydrostatic pressure significantly, and that just leaks out. So in burns or any situation, you try to see why I don't really give 2 litres bolus, I’ll go for a litre bolus and the next litre pretty fast, maybe an hour or two. You don't want to give it as bolus.

02:24 Clinical signs of shock. I’m sure you know this. I’m not going to waste time on this.

02:30 Hypotension, tachypnoea, oliguria, agitation, confusion, coma, slow capillary refill. So these are all signs of SIRS, these are signs of shock. Yeah it is, the oxygen -- What type of antibiotics do you give in...

03:23 In septic shock? It depends on where is the source of infection. If it’s an orthopaedic patient, you go for more of a Cef and Met-Augmentin route. If it is bowel, then you have to cover for coliforms. So in the exam if you get something like a third generation cephalosporin, cefotaxime, that's quite safe. What do you say? Amoxi-Met and Gen, yes, that can be used as well.

03:54 But for the purpose of the exam it's the cephalosporin? Cephalosporin. Yeah, cephalosporin, yeah.

04:19 Now one thing you may be missed in sepsis and is very important, but then you have to support every system. Ionotropes, that has got a very important role. So if at all, you are given a choice, an option of considering ionotropes, be very careful to discount it, because septic shock, you need to peripherally vasoconstrict with some noradrenaline to increase the blood pressure. So make sure that the ionotropes is in your list of priority in septic shock, mainly gram negative sepsis. What's happening here now? Anything else? Severely tachypneic, hypotensive and pretty much oligouric. Anuric, isn't it You won't get this in the exam, this type of X-ray, but what do you think it is? ARDS.

05:19 Yeah okay. But you need to know about ARDS in terms of theory. What's ARDS? How do you diagnose