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61 - Septic Shock

from Part III - Special Populations

Published online by Cambridge University Press:  15 December 2009

Clement Yeh
Affiliation:
Clinical Instructor of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
Robert Rodriguez
Affiliation:
Professor of Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
Rachel L. Chin
Affiliation:
University of California, San Francisco
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Summary

INTRODUCTION

The term sepsis describes a spectrum of pathophysiologic responses to infection. In the setting of advanced antibiotic therapies, sophisticated respiratory and cardiovascular support, and improved diagnosis, sepsis-associated mortality has declined in recent years, though it remains greater than 50% in some groups. Early recognition and aggressive management are critical to reducing morbidity and mortality.

EPIDEMIOLOGY

The causative organisms implicated in sepsis have changed over time, and many cases have nondiagnostic or negative cultures. The identified sites of primary infection are predominantly lung (47%), followed by unknown/other (28%), peritoneum (15%), and urinary tract (10%). Prior to 1987, gram-negative organisms were the predominant organisms identified. In the past 20 years, however, sepsis caused by gram-positive organisms has increased markedly, and gram-positives are now the predominant etiologic agents. Additionally, over the same time period, the incidence of fungal sepsis has increased by over 200%. These changes likely reflect the increased numbers of immunocompromised patients and debilitated surgical patients, and the increased use of indwelling catheters and devices.

CLINICAL FEATURES

The American College of Chest Physicians and the Society of Critical Care Medicine have developed standardized diagnostic criteria for sepsis, severe sepsis, and septic shock to describe the continuum of evolving physiologic derangement (Table 61.1). Categorization of patients in this system provides vital prognostic information and guides critical disposition and treatment decisions.

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Publisher: Cambridge University Press
Print publication year: 2008

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References

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  • Septic Shock
    • By Clement Yeh, Clinical Instructor of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Robert Rodriguez, Professor of Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.062
Available formats
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Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Septic Shock
    • By Clement Yeh, Clinical Instructor of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Robert Rodriguez, Professor of Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.062
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Septic Shock
    • By Clement Yeh, Clinical Instructor of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Robert Rodriguez, Professor of Medicine, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.062
Available formats
×