Pathophysiology of Sepsis
Approach to the Care of the Critically Ill Surgical Patient (CCrISP)
1. Stages
4 stages to consider:
- Initial response -> toll-like receptors detecting Pathogen Associated Molecular Patterns (PAMPS) and Damage Associated Molecular Patterns (DAMPS) eg LPS or heat shock proteins.
- Systemic Inflammatory Response Syndrome
- Septic shock - hypotension reflactory to fluids, leaky glycocalyx, myocardial depression, raising lactate
- MODS
2. Coagulopathy
Extrinsic coagulation cascade from tissue factor. Also suppresses procoagulant pathway (Protein S,C - Antithrombin III) End result in DIC: Widespread microvascular thrombosis → consumption of clotting factors and platelets → consumptive coagulopathy → paradoxical bleeding tendency.