SEPSIS AND

SEPTIC SHOCK
Oleh:
Rifdah
Primayuni Dhia Hasanah

Supervisor: dr. Wiwi Jaya, Sp.An, KIC

1 Pendahuluan

2 Tinjauan Pustaka

3 Kesimpulan

4
Pendahuluan
Background

In US, medical centers reported sepsis as 3 in 1000 cases.

51,1% of those cases admitted to ICU
The incidence of severe sepsis ranged from 0.2 cases per 1000 admissions in children to
26.2 per 1000 in individuals older than 85 years (Kalil, 2018)
In developing countries: 60-80% from all deaths every 3-4 second caused by sepsis
(GSA, 2016)
Indonesia: 48,96% death rate (Pradipta, 2009).
Tinjauan Pustaka
 Definition
Latest Definition 2016
Third International Consensus Definitions for Sepsis and Septic Shock
 Score criteria SOFA: Sequential Organ Failure Assessment
– SEPSIS: a life-threatening organ dysfunction caused by disregulation
host respond to infection. Organ dysfunction evaluated using SOFA
SCORE
– SEPTIC SHOCK: sepsis that causing circulation and cellular/
metabollite abnormality which significant enough to cause mortality
Fluid-unresponsive hypotension
Need for vasopressors to keep MAP >65mmHg
Serum lactate > 2mmol/L

(Singer, et al. JAMA 2016;315(8) 801-810)

Definition
 Etiology

Common source of
Bacterias:
infection: • Positive Gram bacteria
• Lungs (64%), • Negative Gram bacteria
• Abdomen (20%), • Mixed or others

• Blood Circulation (15%)

• Genitourinary tract
• Kidney (14%)
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Hotchkiss et al, Sepsis and Septic Shock, ResearchGate, 2016 : vol. 2 : 1-21
Pathophysiology
 Diagnosis

Anamnesis

Physical
Examination
Workup
Examiniation
 Clinical Manifestation
Hypotension,
Tachypnea Altered Mental Status
tachycardi
•Alveoli capillary membrane •Myocardial depression Lethargy, confuse, delirium 
damage becaused of •Ejectionfraction decrease Airway (ETT)
inflammation  inotropic
•Respiratory alkalosis,
hypoxemia, and/or
hypercarbondioxide

Hepar function Renal disturbance GI symptoms

Increase of ALT & bilirubin • Morbidity  renal failure

• Increasing creatinine
• Avoid  rescucitation

Hotchkiss et al, Sepsis and Septic Shock, ResearchGate, 2016 : vol. 2 : 1-21
 • SOFA score

- PaO2 : FiO2 < 300 mmHg

- Thrombocyte < 100.000/mm3 Fulfill minimum 2 of:
- Bilirubin ≥ 2 mg/dL
- Hypotention that require - Systolic BP ≤ 100 mmHg
vasopresor - RR ≥ 22 x/menit
- GCS ≤ 12 - Altered mental status
- Creatinine ≥ 2 mg/dL or urine
output < 500 mL/day

Each indicator scored 0 (normal) – 4

(organ failure). Total score ≥2 indicates
increase of organ dysfunction risk or
death
• qSOFA score

Makic dan Bridges, Managing Sepsis and Septic Shock : Current Guidelines and Definitions, AJN, 2018 : 118 (2)
 Temuan Laboratorium

Leucocytosis/Leucopenia Trombocytopenia
01 02

Increased CRP Hyperbilirubinemia

06 03

Hyperglicemia Increase lactat compound

05 04
 Management Principles
Monitoring: ECG, vital signs q5min,
Early Recognition pulse oxymetry

Labs: RBS, CBC, Blood and urine

Source Control culture, Haemostasis functions, Serum
electrolyte, ABG, Ur/Cr

Early and adequate antibiotic CXR, consider echocardiography

therapy

Ventilatory support Urinary catheter

Early hemodynamic Maintain airway

resuscitation and support

Managed in resuscitation area Haemodynamic stabilization

(General Principle in Emergency Medicine 2nd edition, 2015)

(Singer, et al. JAMA 2016;315(8) 801-810)
Surviving Sepsis Campaign Update 2018
Prognosis
Thank you