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Shift of foccus from Inflamation to Organ Dysfunction
Sindrom Klinis
Respon Host terhadap
Infeksi
Proses Sistemik
Melibatkan Multi Organ
Sepsis : life-threatening organ dysfunction due to a dysregulated host response to
infection
Severe Sepsis : as sepsis plus sepsis-induced organ dysfunction or tissue
hypoperfution
Septic Shock : a subset of sepsis in which underlying circulatory and celluler/metabolic
abnormalities are profound enough to substantially increase mortality
as sepsis induced hypotension persisting despite adequate fluid
resuscitation, and having serum lactate level >2 mmol/Lgggg
Mortality > 40 %
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)JAMA. 2016;315(8):801-810.
What differentiates sepsis from infection is an aberrant or
dysregulated host response and the presence of organ
dysfunction
Organ dysfunction can be idetified as an acute change in total
SOFA Score >/= 2 points consequent to the infection
A SOFA score >/= 2 reflect ,
Bacterial Product
And Component
Activation of Coagulation
And Complement TNF a
System IL-1
IL-6
Tissue Factor Release
PAF
Fibrinolytic acitvity Macrophage NO
etc
Tissue Injury
Jaundice
Platelets
Enzymes
Albumin PT/APTT
PT Protein
C
D-dimer
Titrate oxygen to a saturation target of 94%
Take blood cultures.
Administer empiric intravenous antibiotics.
Measure serum lactate and send full blood
count.
Start intravenous fluid resuscitation.
Commence accurate urine output
measurement.
Give 3 Take 3
1.OXYGEN: Titrate O2 to saturations 1. CULTURES: Take blood cultures
of 94 -98% or 88-92% in chronic lung before giving antimicrobials (if no
disease. significant delay i.e. >45 minutes)
and consider source control.
No.RM : 11245970
Diagnosa :
MRS
7/3/17
8/3/17 Profilaksis : 9/3/17
Cefoperazon 2 x 1 g Cefoperazon 2 x 1 g
7/3/17
Hematologi Metronidazol 3 x 500 mg
HGB 11,6
8/3/17
RBC 3,97
Hematologi
WBC 21,48 9/3/17
HGB 8,3
PLT 424 Hematologi
RBC 2,83
Eos 0,2 HGB 8,5
WBC 14,48
Baso 0,2 RBC 2,92
PLT 356
Neutro 91,8 WBC 15,28
Eos 0,1
Limfo 4,3 PLT 316
Baso 0,3
Mono 3,5 Eos 0,5
Neutro 92,9
Immatur Granulosit Baso 0,2
Limfo 4,8
0,64 (3%) Neutro 85,3
Mono 1,9
Ur/Cr 101,8/2,05 Limfo 10,4
Immatur Granulosit
CRP Kuanti 25,55 Mono 3,6
0,63 (4,4%)
POCT (15:13) 346 Immatur Granulosit
Ur/Cr 101,8/2,05
POCT (23:33) 299 0,88 (5,8%)
POCT (22:13) 304
As. Laktat 1,2
POCT (04:02) 268
PPAM = Cipro + Genta