Sepsis and Septic Shock in Pregnancy - Children's Memorial ...

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The fundamental clinical problem of sepsis was readilyapparent even to the casual observer over 500 years ago“Hectic fever (sepsis) at itsinception is difficult torecognize but easy to treat.Left untended, it becomes easyto recognize but difficult totreat.”- Circa 1498Steven M. Opal, MDInternational SepsisForum SymposiumSept. 27, 2007Niccolo MachiavelliThe Prince, Book III
Maternal mortality, 1842“It is not by chance that a single obstetrician has 16fatal cases in a single month - I can only dispel thesadness which falls upon me by gazing into thathappy future when the infection will be banished”Ignaz Semmelweis (1818-1865)1840’s:Lying-in HospitalViennaDivided into two clinicsalternatingadmissionsevery 24 hours:1. First Clinic: Doctorsand medical studentsdidautopsies betweendeliveries2. Second Clinic:Midwives-came in offthe street to deliverworegloves outside16141210- Circa 18588642016%First Clinic7%SecondClinicObserved: Doctors’ hands smelled like corpses(putrefied) but not midwifes; death rate went downwhen students on vacation- no autopsies
Page 1 and 2: Sepsis and Septic Shockin Pregnancy
Page 3: Cases / 100,000Deaths/YearCompariso
Page 7 and 8: The Intervention:Hand scrub with ch
Page 9 and 10: Definitions• Sepsis- SIRS due to
Page 11 and 12: Case History• 31 wks, sore throat
Page 13 and 14: Group A StreptococcusThe Etiology,
Page 17 and 18: MicroabscessFascia
Page 19 and 20: Early Goal Directed Therapy• Earl
Page 21 and 22: Mortality (%)The Importance of Earl
Page 23 and 24: Algorithm for Septic Shock in Pregn
Page 25 and 26: Antimicrobial Therapy• Infection
Page 27 and 28: Post-op C/SMultilocularabscessDispl
Page 29 and 30: Postpartumnecrotizingfasciitis
Page 31 and 32: Empiric Antimicrobial Therapy• Ge
Page 33 and 34: Vasoactive Therapy• Indication- H
Page 35 and 36: Corticosteroids• Treat patients w
Page 37 and 38: Presentation: Temp 103.5, severe fl
Page 39 and 40: Maintenance PhaseAnticipation of co
Page 41 and 42: H1N1 influenza-associated ARDS: Bil
Page 43 and 44: Indications for surgical interventi
Page 46 and 47: Obesity Trends*Among U.S. AdultsDon
Page 48 and 49: Outcome
Page 50 and 51: References• Mabie WC, Barton JR,
Page 52 and 53: References• Walsh C, Scaife C, Ho
Page 54 and 55:
References• Kitter ND, McMullen K
Page 56 and 57:
Historical Guidelines for Sepsis Th
Page 58 and 59:
Probability of SurvivalFluid Resusc
Page 60 and 61:
Drotrecogin Alfa (Xigris)• Decrea
Page 62 and 63:
VentricularFunctionGroup INormalGro
Page 64 and 65:
Varicella-Zosterin Pregnancy
Page 66:
BACKGROUNDGlobal• Puerperal sepsi
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