Review Complementary CBC with platelet and leukocyte count (leucopenia: below 5,000 and leukocytosi

Pregnant and postpartum women in the main foci of infection leading to sepsis are the genitourinary tract infections, such as septic abortion, puerperal endometritis, acute pyelonephritis, infection ovulate, septic pelvic thrombophlebitis. The vast majority of sepsis are caused by aerobic gram-negative bacteria (E. coli, Klebsiella, Proteus, Enterobacter, Serratia), associated or not with anaerobes. Phases of Clinical Diagnosis Septic Shock Clinical findings in severe case
Review Complementary CBC with platelet and leukocyte count (leucopenia: below 5,000 and leukocytosis: above 20,000). Arterial blood gases and electrolytes: initial respiratory alkalosis followed organizing tips by metabolic acidosis. Urea and creatinine. Urinalysis: pyuria, hematuria, bacteriuria, and hematuria. Coagulation: prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen. Serum lactate Culture: blood cultures are often negative, thus urine cultures, cultures (including amniotic organizing tips fluid) intrauterine material and surgical wounds may be useful in microbiological identification. Culture of tracheal aspirate or sputum should be performed in patients with respiratory symptoms. Electrocardiogram: continuous monitoring. RX Chest: assessing heart and lungs. Imaging studies of others USG, CT, MRI, it is necessary to locate sources of infection. Conduct a patient in this situation should be conducted at the Intensive Care Unit. In pregnant women the initial goal of treatment is maternal stabilization, avoiding surgical procedures before a breast cardiocirculatory collapse, organizing tips which may increase the risk of death. In other cases, maternal condition stabilized and there are no indications fetal compromise, the obstetric organizing tips management should be defined. Maintain adequate organizing tips oxygenation: must seek to maintain PaO2> 60 mmHg and O2 saturation between 92% - 94% with nasal cannula or mask O2, and may require assisted ventilation. There must be a continuous control of lung function with pulse oximetry or arterial blood gas analysis with intermittently. If peripheral perfusion is inadequate, or if the hemoglobin is low, pulse oximetry may be impaired. The use of assisted ventilation will depend on the gas parameters and experience with the use of respirator should be, preferably, at the discretion of the anesthesiologist or intensivist. Maintain adequate blood volume: fast and controlled organizing tips administration of crystalloid solutions can help to ensure good perfusion of organs and tissues. However, there is the risk of pulmonary edema and ARDS. To control the infusion organizing tips should be used, preferably, the Swan-Ganz. If this is not possible, organizing tips to control through measurement of Central Venous Pressure (looking to keep it between 8-12 cm/H2O). Expansion of intravascular volume with large-bore needle, by means Abocath: infuse organizing tips 250-300 ml of 0.9% saline in 15 minutes. Additional infusions organizing tips of up to a maximum of 2 liters can be administered, monitoring to improve the sensory status, skin color, increased BP (SBP seek to maintain organizing tips above 90 mmHg), decreased pulse monitor with indwelling catheters increased urine output organizing tips (greater or equal 30ml / h). Instituting vasopressor or inotropic therapy to improve cardiac output: If hypotension organizing tips does not respond to the initial fluid infusion, employs the use of inotropic agents under central monitoring. Dopamine is the initial drug of choice: Use of Dopamine: (. 1-3 mcg / kg / min) in low doses activates dopamine receptors, causing vasodilation and increasing the renal, mesenteric, coronary and cerebral blood flow. At intermediate doses (3 - 10. Mcg / kg / min) activates beta-adrenergic organizing tips receptors, with increased myocardial contractility and cardiac function improvement. Active in high doses (above 10 mg / kg / min.) Alfaadrenérgicos receptors, organizing tips causing vasoconstriction in all vascular beds (including the uterus and uteroplacental circulation). If dopamine does not improve blood pressure, use of other drugs will depend to differentiate whether the frame is due to persistent vasodilation or myocardial depression. If the problem is myocardial depression, inotropic therapy (dobutamine 2-20 mcg / kg / min., Or epinephrine 1-8 mcg / kg / min.) Is recommended. If persistent vasodilation, are used peripheral vasoconstrictor (phenylephrine 20-200 ug / min., Norepinephrine or 2-8 mg / min.). Antibiotic therapy: start immediately after collection of cultures and modify therapy, if necessary, when the bacterial agent is identified. organizing tips The antibiotic organizing tips therapy regimens organizing tips should be standardized by agreement between the obstetric service, the service of critical care medicine (if any) and, especially, the service or the infection control committee of the hospital. In most cases, the association between