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Response to foreign body

Response to foreign body. Inflammatory reaction Localized Generalized Generalized inflammatory reaction Infective Noninfective Sepsis: Generalized inflammatory, having systemic signs. Systemic Inflammatory Response Syndrome (SIRS).

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Response to foreign body

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  1. Response to foreign body • Inflammatory reaction • Localized • Generalized • Generalized inflammatory reaction • Infective • Noninfective • Sepsis: Generalized inflammatory, having systemic signs

  2. Systemic Inflammatory Response Syndrome (SIRS) • Patient presents with two or more of the following criteria. • temperature > 38°C or < 36°C • heart rate > 90 beats/minute • respiration > 20/min or PaCO2 < 32mm Hg • leukocyte count > 12,000/mm3, < 4,000/mm3 or > 10% immature (band) cells

  3. Definition • Sepsis: SIRS plus a documented infection site (documented by positive culture for organisms from that site). Blood cultures do NOT need to be positive. While SIRS, sepsis, and septic shock are associated commonly with bacterial infection, bacteremia may not be present. • Septic Shock: Sepsis-induced hypotension despite fluid resuscitation PLUS hypoperfusion abnormalities

  4. Mechanism

  5. Organ Dysfunctions associated with Severe Sepsis and Septic Shock: Lungs: early fall in arterial PO2, capillary-leakage into alveoli; tachypnea, hyperpnea(ARDS). Kidneys :(acute renal failure): oliguria, anuria, azotemia, proteinuria Liver: elevated levels of serum bilirubin, alkaline phosphatase,cholestatic jaundice Heart: cardiac output is initially normal or elevated, Brain : confusion

  6. Organ Dysfunctions contd: • Digestive tract: nausea, vomiting, diarrhea and ileus • Skin: ecthyma gangrenosum (think Pseudomonas aeruginosa in neutropenic patients), Petechia or purpura: (think Neisseria meningitidis or Rickettsia rickettsia: (if evidence of tick bite)), Hemorrhage or bullous lesions Toxic Shock Syndrome: Staphylococcus aureus or Streptococcus pyogenes

  7. Complications: Adult respiratory distress syndrome (ARDS) Disseminated Intravascular Coagulation (DIC) Acute Renal failure (ARF) Intestinal bleeding Liver failure Central Nervous system dysfunction Heart failure Death

  8. When to suspect • Fever or unexplained signs with malignancy or instrumentation • Hypotension Oliguria or anuria • Tachypnea or hyperpnea Hypothermia without obvious cause • Bleeding • High fever and bounding pulse, rigor, purpuric rash, tachypnoea

  9. THERAPY • Immediate Stabilization of the Patient. • The blood must be rapidly cleared of microorganisms • The original focus of infection must be treated.

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