Sepsis is a systemic response of host deleterious to infection leading to severe sepsis (acute orga

The LTI founded in 2007 organizes gutter cleaning tools a course of intensive care annually. It is directed at medical students from the 4th year. At the end of the course, students in 4th year can take the test to make the practical stage, which lasts 12 months in accredited ICUs. This space was created in August 2009, and then abandoned. It was rebuilt gutter cleaning tools in March 2012, aiming to give information about intensive for those who are entering this universe first medicine.
Sepsis is a systemic response of host deleterious to infection leading to severe sepsis (acute organ dysfunction secondary to known or suspected infection) and septic shock (severe sepsis plus hypotension gutter cleaning tools not reversed with fluid resuscitation). Severe sepsis and septic shock are major health problems, affecting millions of people around the world each year, killing one in four (and sometimes more), and increasing in incidence (1-5). Similar to multiple trauma, acute myocardial infarction infarction or stroke, the speed of adjustment gutter cleaning tools of therapy administered in the first hours after severe sepsis develops are likely to influence the outcome.
Diagnostic criteria for sepsis: Infection, documented or suspected, and some of the following: 1. General variables: fever (> 38.3 C) and hypothermia (core temperature C) Heart rate> 90/min-1 two or more sdabove normal for age Tachypnea altered mental status or significant edema balance value Fluid positive (> 20 ml / kg over 24 hr) hyperglycemia gutter cleaning tools (plasma glucose> 140 mg / dL or 7.7 mmol / L) in the absence gutter cleaning tools of diabetes 2. Inflammatory variables: leukocytosis (WBC count> 12,000) Leukopenia (leukocyte count <4,000) Normal WBC count with more than 10% of immature C-Reactive Protein Plasma over two sdabove normal value Procalcitonin plasma over two sdabove normal value
3. Hemodynamic variables: arterial hypotension (SBP mmHg, mean <70 mmHg, or a decrease in SBP> 40 mm Hg for adults or less than two SD below normal for age)
4. Variables of organ dysfunction: arterial hypoxemia (Pao 2 / FiO 2 <300) Acute Oliguria (ml / kg / h urine output for at least two hours, despite adequate volume gutter cleaning tools resuscitation) Increased gutter cleaning tools creatinine> 0.5 mg / dL or 44 , 2 mmol / L Coagulation disorders (INR> 1.5 or aPTT> 60 s) ileus (absent bowel sounds) Thrombocytopenia (platelet count <100,000) hyperbilirubinemia (total bilirubin in plasma> 4 mg / L or 70 nmol / L)
5. Variables tissue perfusion: Hyperlactatemia (> 1 mmol / L) or capillary refill spots decreased WBC = white blood cells *, SBP = systolic blood pressure, MAP = mean arterial pressure, international normalized ratio INR = partial thromboplastin time, aPTT = activated gutter cleaning tools time . * The diagnostic criteria for sepsis in the pediatric population are signs and symptoms of inflammation plus infection with hyper-or hypothermia (rectal temperature> 38.5 or <35 C), tachycardia (may be absent gutter cleaning tools in hypothermic patients), and at least one of the following indications of altered organ function: gutter cleaning tools altered mental status, hypoxemia, increased serum lactate level, or bounding pulses.
Severe Sepsis Sepsis-induced tissue perfusion and organ dysfunction (any of the following probably due to infection). Sepsis-induced lactate above the upper limits of normal laboratory hypotension Urine output Acute lung injury with PaO2 / FIO2 Acute lung injury with PaO2 / FIO2 creatinine> 2.0 mg / dL (176.8 mmol / L) Bilirubin> 2 mg / dL (34.2 nmol / L) Platelet count The coagulopathy (international normalized ratio> 1.5)
Recommendations: Resuscitation and Infection initial questions: A. initial resuscitation 1. Docketed, quantitative resuscitation of patients with sepsis-induced tissue hypoperfusion (defined herein as hypotension persisting after initial fluid replacement or lactate 4 mmol / L). Goals during the first six hours of resuscitation: gutter cleaning tools a) The central gutter cleaning tools venous pressure 8-12 mm Hg b) Mean arterial pressure (MAP) 65 mmHg c) urine output 0.5 ml / kg / hr d) Central venous (superior vena cava) or oxygen saturation in mixed venous blood, 70% or 65%, respectively. 2. In patients with elevated lactate levels targeting resuscitation to normalize lactate.
B.Triagem for Sepsis and Performance Improvement: 1. Routine screening of potentially infected patients for severe sepsis to allow early implementation of treatment. 2. Hospital-based efforts to improve performance in severe sepsis (UG)
C. Diagnosis: 1. Cultures gutter cleaning tools as clinicame