106-735: Zeiger is a surname of German and Ashkenazic origin. Notable people with the surname include: Larry King , born Lawrence Harvey Zeiger. American television and radio host. Hans Zeiger . United States politician and member of Washington State Senate . Joanna Zeiger . United States triathlete . David Zeiger . Brazilian industrialist. Mila Zeiger . Brazilian businesswoman. Roni Zeiger . United States physician. Eliezer (Eduardo) Zeiger . United States biologist. David Zeiger . United States film director and producer. Yitzhak Seiger . Israeli politician Igor Zeiger . Israeli artist [REDACTED] Surname list This page lists people with
212-412: A fever . Severe sepsis causes poor organ function or blood flow. The presence of low blood pressure , high blood lactate , or low urine output may suggest poor blood flow. Septic shock is low blood pressure due to sepsis that does not improve after fluid replacement . Sepsis is caused by many organisms including bacteria, viruses, and fungi. Common locations for the primary infection include
318-448: A focus of infection and reduce conditions favorable to microorganism growth or host defense impairment, such as drainage of pus from an abscess . It is one of the oldest procedures for control of infections, giving rise to the Latin phrase Ubi pus, ibi evacua , and remains important despite the emergence of more modern treatments. Early goal directed therapy (EGDT) is an approach to
424-488: A "host" discussing products like omega-3 fatty acid dietary supplement OmegaXL with guests, in an interview style reminiscent of his past television programs. ProPublica reported that in 2019 King had been manipulated into starring in a fake interview with a Russian journalist containing disinformation about Chinese dissident Guo Wengui , which was subsequently spread by Chinese government associated social media accounts. Following his 1987 heart attack, King founded
530-520: A PAMP and a PRR will cause a series of intracellular signalling cascades. Consequentially, transcription factors such as nuclear factor-kappa B and activator protein-1 , will up-regulate the expression of pro-inflammatory and anti-inflammatory cytokines. Upon detection of microbial antigens , the host systemic immune system is activated. Immune cells not only recognise pathogen-associated molecular patterns but also damage-associated molecular patterns from damaged tissues. An uncontrolled immune response
636-628: A change in the risk of death with etomidate. Paralytic agents are not suggested for use in sepsis cases in the absence of ARDS , as a growing body of evidence points to reduced durations of mechanical ventilation , ICU and hospital stays. However, paralytic use in ARDS cases remains controversial. When appropriately used, paralytics may aid successful mechanical ventilation, however, evidence has also suggested that mechanical ventilation in severe sepsis does not improve oxygen consumption and delivery. Source control refers to physical interventions to control
742-554: A deficiency of chemicals that constrict blood vessels such as vasopressin , and activation of ATP-sensitive potassium channels . In those with severe sepsis and septic shock, this sequence of events leads to a type of circulatory shock known as distributive shock . Early diagnosis is necessary to properly manage sepsis, as the initiation of rapid therapy is key to reducing deaths from severe sepsis. Some hospitals use alerts generated from electronic health records to bring attention to potential cases as early as possible. Within
848-462: A fast heart rate , confusion , and edema . Early signs include a rapid heart rate, decreased urination , and high blood sugar . Signs of established sepsis include confusion, metabolic acidosis (which may be accompanied by a faster breathing rate that leads to respiratory alkalosis ), low blood pressure due to decreased systemic vascular resistance , higher cardiac output , and disorders in blood-clotting that may lead to organ failure. Fever
954-529: A fee to RT America by New York-based Ora TV. "It's a deal made between the companies ... They just license our shows. If they took something out, I would never do it. It would be bad if they tried to edit out things. I wouldn't put up with it." King remained active as a writer and television personality thereafter. King guest starred in episodes of Arthur , 30 Rock and Gravity Falls , had cameos in Ghostbusters and Bee Movie , and voiced Doris
1060-622: A late-night radio host and sports commentator following his arrest for grand larceny by a former business partner, Louis Wolfson . Other staff covered the Dolphins ' games into their 24–3 loss to the Dallas Cowboys in Super Bowl VI . King also lost his weekly column at the Miami Beach Sun newspaper. The charges were later dropped. King was later rehired by WIOD. For several years during
1166-435: A mean arterial pressure of between 65 and 90 mmHg, a central venous oxygen saturation (ScvO 2 ) greater than 70% and a urine output of greater than 0.5 mL/kg/hour. The goal is to optimize oxygen delivery to tissues and achieve a balance between systemic oxygen delivery and demand. An appropriate decrease in serum lactate may be equivalent to ScvO 2 and easier to obtain. In the original trial, early goal-directed therapy
SECTION 10
#17330854876721272-757: A mid-morning show for WIOD from Pumpernik's Restaurant in Miami Beach. He would interview whoever walked in. His first interview was with a waiter at the restaurant. Two days later, singer Bobby Darin , in Miami for a concert that evening, walked into Pumpernik's having heard King's radio show; Darin became King's first celebrity interview guest. King's Miami radio show brought him local attention. A few years later, in May 1960, he hosted Miami Undercover , airing Sunday nights at 11:30 p.m. on Miami television station WPST-TV . King credited his success on local television to
1378-493: A million cases per year in the United States. Rates of disease have been increasing. Some data indicate that sepsis is more common among males than females, however, other data show a greater prevalence of the disease among women. Descriptions of sepsis date back to the time of Hippocrates . In addition to symptoms related to the actual cause, people with sepsis may have a fever , low body temperature , rapid breathing ,
1484-456: A multi-year deal with Hulu to exclusively carry King's new talk-oriented web series, Larry King Now , beginning July 17. On October 23, 2012, King hosted the third-party presidential debate on Ora TV, featuring Jill Stein , Rocky Anderson , Virgil Goode , and Gary Johnson . In May 2013, the Russian government-owned RT America network announced that they struck a deal with Ora TV to host
1590-413: A new consensus was reached to replace screening by systemic inflammatory response syndrome (SIRS) with the sequential organ failure assessment ( SOFA score ) and the abbreviated version ( qSOFA ). The three criteria for the qSOFA score include a respiratory rate greater than or equal to 22 breaths per minute, systolic blood pressure 100 mmHg or less and altered mental status. Sepsis is suspected when 2 of
1696-768: A public high school in Brooklyn. When King was nine years old, his father died of a heart attack. This resulted in King, his mother, and brother going on government welfare . King was greatly affected by his father's death, and subsequently lost interest in his schoolwork. Throughout King's adolescence, his family lived at 2136 83rd Street in the Bensonhurst section of Brooklyn. After graduating from high school, King worked to help support his mother. From an early age, he desired to work in radio broadcasting. A CBS production supervisor, James F. Sirmons , suggested he go to Florida, which
1802-417: A short interview with King. The interview had been edited without King's permission to make it appear that Holzapfel had appeared on Larry King Now . A default judgment was entered in King's favor, and he was awarded fees and $ 250,000 in damages. King was married eight times to seven women. King married high school sweetheart Freda Miller in 1952, at the age of 19. That union ended the following year at
1908-469: A sportscast. He was paid $ 50 a week. He acquired the name Larry King when the general manager declared that Zeiger was too difficult to remember, saying it was "too German, too Jewish and not showbusiness enough". Minutes before airtime, Larry chose the surname "King", which was inspired from a Miami Herald advertisement he saw for King's Wholesale Liquor. Within two years, he legally changed his name to Larry King. King began to conduct interviews on
2014-648: A state of adrenal insufficiency and tissue resistance to corticosteroids may occur. This has been termed critical illness–related corticosteroid insufficiency . Treatment with corticosteroids might be most beneficial in those with septic shock and early severe ARDS, whereas its role in others such as those with pancreatitis or severe pneumonia is unclear. However, the exact way of determining corticosteroid insufficiency remains problematic. It should be suspected in those poorly responding to resuscitation with fluids and vasopressors. Neither ACTH stimulation testing nor random cortisol levels are recommended to confirm
2120-525: A storyline involving professional wrestlers The Miz and Kofi Kingston . King became a very active user on the social-networking site Twitter, where he posted thoughts and commented on a wide variety of subjects. King stated, "I love tweeting, I think it's a different world we've entered. When people were calling in, they were calling into the show and now on Twitter, I'm giving out thoughts, opinions. The whole concept has changed." After 2011, he also made various television infomercials , often appearing as
2226-666: A thank you to his audience for watching and supporting him over the years. The concluding words of Larry King on the show were, "I... I, I don't know what to say except to you, my audience, thank you. And instead of goodbye, how about so long." On February 17, 2012, CNN announced that he would no longer host specials. In March 2012, King co-founded Ora TV , a production company, with his wife Shawn Southwick-King and Mexican business magnate Carlos Slim . On January 16, 2013, Ora TV celebrated their 100th episode of Larry King Now . In September 2017, King's agent stated that King "looks forward to working for another 60 years." Ora TV signed
SECTION 20
#17330854876722332-399: Is also correlated with an increased chance that someone with sepsis will benefit from and respond to IV fluids . Infections leading to sepsis are usually bacterial but may be fungal , parasitic , or viral . Gram-positive bacteria were the primary cause of sepsis before the introduction of antibiotics in the 1950s. After the introduction of antibiotics, gram-negative bacteria became
2438-477: Is associated with lower mortality in sepsis. The differential diagnosis for sepsis is broad and has to examine (to exclude) the non-infectious conditions that may cause the systemic signs of SIRS: alcohol withdrawal , acute pancreatitis , burns , pulmonary embolism , thyrotoxicosis , anaphylaxis , adrenal insufficiency , and neurogenic shock . Hyperinflammatory syndromes such as hemophagocytic lymphohistiocytosis (HLH) may have similar symptoms and are on
2544-457: Is controversial, with some reviews finding benefit, and others not. Disease severity partly determines the outcome. The risk of death from sepsis is as high as 30%, while for severe sepsis it is as high as 50%, and septic shock 80%. Sepsis affected about 49 million people in 2017, with 11 million deaths (1 in 5 deaths worldwide). In the developed world , approximately 0.2 to 3 people per 1000 are affected by sepsis yearly, resulting in about
2650-484: Is different from Wikidata All set index articles Larry King Larry King (born Lawrence Harvey Zeiger ; November 19, 1933 – January 23, 2021) was an American author, radio host and TV host. His awards and nominations include two Peabodys , an Emmy , and 10 Cable ACE Awards . King was also awarded a Lifetime Achievement Award at the 32nd Annual News and Documentary Emmys. During his career, King conducted over 50,000 interviews on radio and TV. King
2756-493: Is followed by suppression of the immune system . Common signs and symptoms include fever , increased heart rate , increased breathing rate , and confusion . There may also be symptoms related to a specific infection, such as a cough with pneumonia , or painful urination with a kidney infection . The very young, old, and people with a weakened immune system may have no symptoms of a specific infection, and their body temperature may be low or normal instead of constituting
2862-433: Is helpful when looking for the possible location of the infection. Other potential causes of similar signs and symptoms include anaphylaxis , adrenal insufficiency , low blood volume , heart failure , and pulmonary embolism . Sepsis requires immediate treatment with intravenous fluids and antimicrobial medication. Ongoing care often continues in an intensive care unit . If an adequate trial of fluid replacement
2968-485: Is important in determining the survival of the person. Some recommend they be given within one hour of making the diagnosis, stating that for every hour of delay in the administration of antibiotics, there is an associated 6% rise in mortality. Others did not find a benefit with early administration. Several factors determine the most appropriate choice for the initial antibiotic regimen. These factors include local patterns of bacterial sensitivity to antibiotics, whether
3074-475: Is no myocardial ischemia , hypoxemia , or acute bleeding. In a 2014 trial, blood transfusions to keep target hemoglobin above 70 or 90 g/L did not make any difference to survival rates; meanwhile, those with a lower threshold of transfusion received fewer transfusions in total. Erythropoietin is not recommended in the treatment of anemia with septic shock because it may precipitate blood clotting events. Fresh frozen plasma transfusion usually does not correct
3180-737: Is not enough to maintain blood pressure, then the use of medications that raise blood pressure becomes necessary. Mechanical ventilation and dialysis may be needed to support the function of the lungs and kidneys, respectively. A central venous catheter and an arterial catheter may be placed for access to the bloodstream and to guide treatment. Other helpful measurements include cardiac output and superior vena cava oxygen saturation . People with sepsis need preventive measures for deep vein thrombosis , stress ulcers , and pressure ulcers unless other conditions prevent such interventions. Some people might benefit from tight control of blood sugar levels with insulin . The use of corticosteroids
3286-450: Is not intended to replace the SIRS definition. qSOFA has also been found to be poorly sensitive though decently specific for the risk of death with SIRS possibly better for screening. NOTE - Surviving Sepsis Campaign 2021 Guidelines recommends "against using qSOFA compared with SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock". Examples of end-organ dysfunction include
Zeiger - Misplaced Pages Continue
3392-563: Is not recommended in people who has SIRS without any infectious origin such as acute pancreatitis and burns unless sepsis is suspected. Once-daily dosing of aminoglycoside is sufficient to achieve peak plasma concentration for a clinical response without kidney toxicity. Meanwhile, for antibiotics with low volume distribution (vancomycin, teicoplanin, colistin), a loading dose is required to achieve an adequate therapeutic level to fight infections. Frequent infusions of beta-lactam antibiotics without exceeding total daily dose would help to keep
3498-477: Is often used as a first-line treatment for hypotensive septic shock because evidence shows that there is a relative deficiency of vasopressin when shock continues for 24 to 48 hours. Norepinephrine raises blood pressure through a vasoconstriction effect, with little effect on stroke volume and heart rate. In some people, the required dose of vasopressor needed to increase the mean arterial pressure can become exceedingly high that it becomes toxic. In order to reduce
3604-532: Is poor. Within twelve hours, it is essential to diagnose or exclude any source of infection that would require emergent source control, such as a necrotizing soft tissue infection, an infection causing inflammation of the abdominal cavity lining , an infection of the bile duct , or an intestinal infarction. A pierced internal organ (free air on an abdominal X-ray or CT scan), an abnormal chest X-ray consistent with pneumonia (with focal opacification), or petechiae , purpura , or purpura fulminans may indicate
3710-624: Is recommended as the fluid of choice for resuscitation. Albumin can be used if a large amount of crystalloid is required for resuscitation. Crystalloid solutions shows little difference with hydroxyethyl starch in terms of risk of death. Starches also carry an increased risk of acute kidney injury , and need for blood transfusion. Various colloid solutions (such as modified gelatin) carry no advantage over crystalloid. Albumin also appears to be of no benefit over crystalloids. The Surviving Sepsis Campaign recommended packed red blood cells transfusion for hemoglobin levels below 70 g/L if there
3816-702: Is recommended for moderate to severe ARDS in sepsis as it opens more lung units for oxygen exchange. Predicted body weight is calculated based on sex and height, and tools for this are available. Recruitment maneuvers may be necessary for severe ARDS by briefly raising the transpulmonary pressure. It is recommended that the head of the bed be raised if possible to improve ventilation. However, β2 adrenergic receptor agonists are not recommended to treat ARDS because it may reduce survival rates and precipitate abnormal heart rhythms . A spontaneous breathing trial using continuous positive airway pressure (CPAP), T piece, or inspiratory pressure augmentation can be helpful in reducing
3922-453: Is recommended. For methicillin-resistant Staphylococcus aureus (MRSA), vancomycin or teicoplanin is recommended. For Legionella infection, addition of macrolide or fluoroquinolone is chosen. If fungal infection is suspected, an echinocandin , such as caspofungin or micafungin , is chosen for people with severe sepsis, followed by triazole ( fluconazole and itraconazole ) for less ill people. Prolonged antibiotic prophylaxis
4028-423: Is the most common presenting symptom in sepsis, but fever may be absent in some people such as the elderly or those who are immunocompromised. The drop in blood pressure seen in sepsis can cause lightheadedness and is part of the criteria for septic shock . Oxidative stress is observed in septic shock, with circulating levels of copper and vitamin C being decreased. Diastolic blood pressure falls during
4134-413: Is then activated because leukocytes are not recruited to the specific site of infection, but instead they are recruited all over the body. Then, an immunosuppression state ensues when the proinflammatory T helper cell 1 (TH1) is shifted to TH2, mediated by interleukin 10 , which is known as "compensatory anti-inflammatory response syndrome". The apoptosis (cell death) of lymphocytes further worsens
4240-503: The Larry King Now show on its network. King said in an advertisement on RT America: "I would rather ask questions to people in positions of power, instead of speaking on their behalf." The show continued to be available on Hulu.com and Ora.tv. When criticized for doing business with a Russian-owned TV network in 2014, King responded, "I don't work for RT", commenting that his podcasts, Larry King Now and Politicking , are licensed for
4346-574: The Mutual Broadcasting System . From 1985 to 2010, he hosted the nightly interview television program Larry King Live on CNN . King hosted Larry King Now from 2012 to 2020, which aired on Hulu , Ora TV , and RT America . He hosted Politicking with Larry King , a weekly political talk show, on the same three channels from 2013 to 2020. King also appeared in television series and films, usually playing himself. He remained active until his death in 2021. On January 2, 2021, King
Zeiger - Misplaced Pages Continue
4452-482: The cells lining blood vessels , leading to endothelial damage. The damaged endothelial surface inhibits anticoagulant properties as well as increases antifibrinolysis , which may lead to intravascular clotting, the formation of blood clots in small blood vessels, and multiple organ failure . The low blood pressure seen in those with sepsis is the result of various processes, including excessive production of chemicals that dilate blood vessels such as nitric oxide ,
4558-593: The central venous pressure reaches 8–12 mmHg. Once these goals are met, the central venous oxygen saturation (ScvO2), i.e., the oxygen saturation of venous blood as it returns to the heart as measured at the vena cava, is optimized. If the ScvO2 is less than 70%, blood may be given to reach a hemoglobin of 10 g/dL and then inotropes are added until the ScvO2 is optimized. In those with acute respiratory distress syndrome (ARDS) and sufficient tissue blood fluid, more fluids should be given carefully. Crystalloid solution
4664-561: The peptidoglycan of the gram-positive bacterial cell wall, and CpG bacterial DNA . These PAMPs are recognized by the pattern recognition receptors (PRRs) of the innate immune system, which may be membrane-bound or cytosolic. There are four families of PRRs: the toll-like receptors , the C-type lectin receptors, the NOD-like receptors , and the RIG-I-like receptors . Invariably, the association of
4770-401: The quick SOFA score (qSOFA), replaced the SIRS system of diagnosis. qSOFA criteria for sepsis include at least two of the following three: increased breathing rate, change in the level of consciousness, and low blood pressure. Sepsis guidelines recommend obtaining blood cultures before starting antibiotics; however, the diagnosis does not require the blood to be infected . Medical imaging
4876-441: The surname Zeiger . If an internal link intending to refer to a specific person led you to this page, you may wish to change that link by adding the person's given name (s) to the link. Retrieved from " https://en.wikipedia.org/w/index.php?title=Zeiger&oldid=1185601407 " Categories : Surnames German-language surnames Hidden categories: Articles with short description Short description
4982-446: The 1970s, he hosted a sports talk-show called Sports-a-la-King , featuring guests and callers. On January 30, 1978, King began hosting a nightly coast-to-coast radio program on the Mutual Broadcasting System , inheriting the talk show slot that had begun with Herb Jepko in late 1975, then followed by "Long John" Nebel in 1977. King's Mutual show rapidly developed a devoted audience, called "King-aholics". The Larry King Show
5088-651: The Larry King Cardiac Foundation, a non-profit organization which paid for life-saving cardiac procedures for people who otherwise would not be able to afford them. On August 30, 2010, King served as the host of Chabad 's 30th annual "To Life" telethon, in Los Angeles. He donated to the Beverly Hills 9/11 Memorial Garden , where his name is on the monument. King resided in Beverly Hills, California . A lifelong Brooklyn / Los Angeles Dodgers fan, he
5194-591: The PCT to direct antibiotic therapy for improved antibiotic stewardship and better patient outcomes. A 2012 systematic review found that soluble urokinase-type plasminogen activator receptor (SuPAR) is a nonspecific marker of inflammation and does not accurately diagnose sepsis. This same review concluded, however, that SuPAR has prognostic value, as higher SuPAR levels are associated with an increased rate of death in those with sepsis. Serial measurement of lactate levels (approximately every 4 to 6 hours) may guide treatment and
5300-746: The Ugly Stepsister in Shrek 2 and its sequels. He also played himself in The People v. O. J. Simpson: American Crime Story and appeared as himself in an episode of Law and Order: Trial by Jury . King hosted the educational television series In View with Larry King from 2013 to 2015, which was carried on cable television networks including Fox Business Network and Discovery and produced by The Profiles Series production company. King and his wife Shawn appeared on WWE Raw in October 2012, participating in
5406-462: The absence of antigen presentation . This forced receptor interaction induces the production of pro-inflammatory chemical signals ( cytokines ) by T-cells. There are a number of microbial factors that may cause the typical septic inflammatory cascade . An invading pathogen is recognized by its pathogen-associated molecular patterns (PAMPs). Examples of PAMPs include lipopolysaccharides and flagellin in gram-negative bacteria, muramyl dipeptide in
SECTION 50
#17330854876725512-464: The antibiotics level above minimum inhibitory concentration (MIC), thus providing a better clinical response. Giving beta-lactam antibiotics continuously may be better than giving them intermittently. Access to therapeutic drug monitoring is important to ensure adequate drug therapeutic level while at the same time preventing the drug from reaching toxic level. The Surviving Sepsis Campaign has recommended 30 mL/kg of fluid to be given in adults in
5618-462: The assistance of comedian Jackie Gleason , whose national television variety show was being taped in Miami Beach, beginning in 1964. "That show really took off because Gleason came to Miami," King said in a 1996 interview he gave when inducted into the Broadcasters' Hall of Fame. "He did that show and stayed all night with me. We stayed till five in the morning. He didn't like the set, so we broke into
5724-498: The audience by telling amusing stories from his youth or early broadcasting career. Wishing to reduce his workload, King began hosting a shorter, daytime version of the show in 1993. Jim Bohannon , King's primary fill-in host, took over the late night time slot. After 16 years on Mutual, King decided to retire from the program. The final broadcast of The Larry King Show was heard on May 27, 1994; Mutual gave King's afternoon slot to David Brenner and Mutual's affiliates were given
5830-481: The behest of their parents, who reportedly had the marriage annulled . King was married to Annette Kaye, who gave birth to his son, Larry Jr., in November 1961. King did not meet Larry Jr. until the latter was in his 30s. Sepsis Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage of sepsis
5936-425: The blood also does not demonstrate any survival benefit for septic shock. If the person has been sufficiently fluid resuscitated but the mean arterial pressure is not greater than 65 mmHg, vasopressors are recommended. Norepinephrine (noradrenaline) is recommended as the initial choice. Delaying initiation of vasopressor therapy during septic shock is associated with increased mortality. Norepinephrine
6042-546: The blood pressure should be adequate, close monitoring of blood pressure and blood supply to organs should be in place, and the lactate should be measured again if initially it was raised. A related bundle, the " Sepsis Six ", is in widespread use in the United Kingdom ; this requires the administration of antibiotics within an hour of recognition, blood cultures, lactate, and hemoglobin determination, urine output monitoring, high-flow oxygen, and intravenous fluids. Apart from
6148-528: The diagnosis. The method of stopping glucocorticoid drugs is variable, and it is unclear whether they should be slowly decreased or simply abruptly stopped. However, the 2016 Surviving Sepsis Campaign recommended to taper steroids when vasopressors are no longer needed. A target tidal volume of 6 mL/kg of predicted body weight (PBW) and a plateau pressure less than 30 cm H 2 O is recommended for those who require ventilation due to sepsis-induced severe ARDS. High positive end expiratory pressure (PEEP)
6254-499: The differential diagnosis. In common clinical usage, neonatal sepsis refers to a bacterial blood stream infection in the first month of life, such as meningitis , pneumonia , pyelonephritis , or gastroenteritis , but neonatal sepsis also may be due to infection with fungi, viruses, or parasites. Criteria with regard to hemodynamic compromise or respiratory failure are not useful because they present too late for intervention. Early recognition and focused management may improve
6360-415: The duration of ventilation. Minimizing intermittent or continuous sedation is helpful in reducing the duration of mechanical ventilation. General anesthesia is recommended for people with sepsis who require surgical procedures to remove the infective source. Usually, inhalational and intravenous anesthetics are used. Requirements for anesthetics may be reduced in sepsis. Inhalational anesthetics can reduce
6466-444: The early stages of sepsis, causing a widening/increasing of pulse pressure , which is the difference between the systolic and diastolic blood pressures. If sepsis becomes severe and hemodynamic compromise advances, the systolic pressure also decreases, causing a narrowing/decreasing of pulse pressure. A pulse pressure of over 70 mmHg in patients with sepsis is correlated with an increased chance of survival. A widened pulse pressure
SECTION 60
#17330854876726572-418: The first three hours followed by fluid titration according to blood pressure, urine output, respiratory rate, and oxygen saturation with a target mean arterial pressure (MAP) of 65 mmHg. In children an initial amount of 20 mL/kg is reasonable in shock. In cases of severe sepsis and septic shock where a central venous catheter is used to measure blood pressures dynamically, fluids should be administered until
6678-456: The first three hours of suspected sepsis, diagnostic studies should include white blood cell counts , measuring serum lactate, and obtaining appropriate cultures before starting antibiotics, so long as this does not delay their use by more than 45 minutes. To identify the causative organism(s), at least two sets of blood cultures using bottles with media for aerobic and anaerobic organisms are necessary. At least one should be drawn through
6784-499: The following: More specific definitions of end-organ dysfunction exist for SIRS in pediatrics. Consensus definitions, however, continue to evolve, with the latest expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience. Biomarkers can help diagnosis because they can point to the presence or severity of sepsis, although their exact role in the management of sepsis remains undefined. A 2013 review concluded moderate-quality evidence exists to support
6890-544: The general manager's office and changed the set. Gleason changed the set, he changed the lighting, and he became like a mentor of mine." During this period, WIOD gave King further exposure as a color commentator for the Miami Dolphins of the National Football League , during their 1970 season and most of their 1971 season. On December 20, 1971, he was dismissed by both WIOD and television station WTVJ as
6996-497: The heart, finger/toes, and abdominal organs, resulting in a lack of oxygen supply to these tissues. Dopamine is typically not recommended. Although dopamine is useful to increase the stroke volume of the heart, it causes more abnormal heart rhythms than norepinephrine and also has an immunosuppressive effect. Dopamine is not proven to have protective properties on the kidneys. Dobutamine can also be used in hypotensive septic shock to increase cardiac output and correct blood flow to
7102-583: The heart, impaired calcium transport, and low production of adenosine triphosphate (ATP), can cause myocardial depression, reducing cardiac contractility and causing heart failure . In the gastrointestinal tract , increased permeability of the mucosa alters the microflora, causing mucosal bleeding and paralytic ileus . In the central nervous system , direct damage of the brain cells and disturbances of neurotransmissions causes altered mental status. Cytokines such as tumor necrosis factor , interleukin 1 , and interleukin 6 may activate procoagulation factors in
7208-474: The host. Sepsis caused by gram-negative bacteria is thought to be largely due to a response by the host to the lipid A component of lipopolysaccharide , also called endotoxin . Sepsis caused by gram-positive bacteria may result from an immunological response to cell wall lipoteichoic acid . Bacterial exotoxins that act as superantigens also may cause sepsis. Superantigens simultaneously bind major histocompatibility complex and T-cell receptors in
7314-497: The immune system . Either of these phases may prove fatal. On the other hand, systemic inflammatory response syndrome (SIRS) occurs in people without the presence of infection, for example, in those with burns , polytrauma , or the initial state in pancreatitis and chemical pneumonitis . However, sepsis also causes similar response to SIRS. Bacterial virulence factors , such as glycocalyx and various adhesins , allow colonization, immune evasion, and establishment of disease in
7420-484: The immunosuppression. Neutrophils , monocytes , macrophages , dendritic cells , CD4+ T cells , and B cells all undergo apoptosis, whereas regulatory T cells are more apoptosis resistant. Subsequently, multiple organ failure ensues because tissues are unable to use oxygen efficiently due to inhibition of cytochrome c oxidase . Inflammatory responses cause multiple organ dysfunction syndrome through various mechanisms as described below. Increased permeability of
7526-406: The infection is thought to be a hospital or community-acquired infection, and which organ systems are thought to be infected. Antibiotic regimens should be reassessed daily and narrowed if appropriate. Treatment duration is typically 7–10 days with the type of antibiotic used directed by the results of cultures. If the culture result is negative, antibiotics should be de-escalated according to
7632-512: The initiation of antibiotics. Cultures from other sites such as respiratory secretions, urine, wounds, cerebrospinal fluid, and catheter insertion sites (in-situ more than 48 hours) are recommended if infections from these sites are suspected. In severe sepsis and septic shock, broad-spectrum antibiotics (usually two, a β-lactam antibiotic with broad coverage, or broad-spectrum carbapenem combined with fluoroquinolones , macrolides , or aminoglycosides ) are recommended. The choice of antibiotics
7738-574: The leading figures of his time. According to CNN, King conducted more than 30,000 interviews in his career. An avid sports fan, King wrote a regular column for The Sporting News during the 1980s. King also wrote a regular column in USA Today for almost 20 years, from shortly after that first national newspaper's debut in Baltimore–Washington in 1982 until September 2001. The column consisted of short "plugs, superlatives and dropped names" but
7844-510: The level of proinflammatory cytokines, altering leukocyte adhesion and proliferation, inducing apoptosis (cell death) of the lymphocytes, possibly with a toxic effect on mitochondrial function. Although etomidate has a minimal effect on the cardiovascular system, it is often not recommended as a medication to help with intubation in this situation due to concerns it may lead to poor adrenal function and an increased risk of death. The small amount of evidence there is, however, has not found
7950-451: The lung vessels causes leaking of fluids into alveoli, which results in pulmonary edema and acute respiratory distress syndrome (ARDS). Impaired utilization of oxygen in the liver impairs bile salt transport, causing jaundice (yellowish discoloration of the skin). In kidneys, inadequate oxygenation results in tubular epithelial cell injury (of the cells lining the kidney tubules), and thus causes acute kidney injury (AKI). Meanwhile, in
8056-468: The lungs, brain, urinary tract , skin, and abdominal organs . Risk factors include being very young or old, a weakened immune system from conditions such as cancer or diabetes , major trauma , and burns . Previously, a sepsis diagnosis required the presence of at least two systemic inflammatory response syndrome (SIRS) criteria in the setting of presumed infection. In 2016, a shortened sequential organ failure assessment score (SOFA score), known as
8162-406: The lungs. In one-third to one-half of cases, the source of infection is unclear. Sepsis is caused by a combination of factors related to the particular invading pathogen(s) and to the status of the immune system of the host. The early phase of sepsis characterized by excessive inflammation (sometimes resulting in a cytokine storm ) may be followed by a prolonged period of decreased functioning of
8268-427: The management of severe sepsis during the initial 6 hours after diagnosis. It is a step-wise approach, with the physiologic goal of optimizing cardiac preload, afterload, and contractility. It includes giving early antibiotics. EGDT also involves monitoring of hemodynamic parameters and specific interventions to achieve key resuscitation targets which include maintaining a central venous pressure between 8–12 mmHg,
8374-437: The most common cause of fungal sepsis is an infection by Candida species of yeast , a frequent hospital-acquired infection . The most common causes for parasitic sepsis are Plasmodium (which leads to malaria ), Schistosoma and Echinococcus . The most common sites of infection resulting in severe sepsis are the lungs, the abdomen, and the urinary tract. Typically, 50% of all sepsis cases start as an infection in
8480-668: The option of carrying the audio of King's new CNN evening television program. After Westwood One dissolved Mutual in 1999, the radio simulcast of the CNN show continued until December 31, 2009. Larry King Live began on CNN in June 1985. King hosted a broad range of guests, from figures such as UFO conspiracy theorists and alleged psychics , to prominent politicians and entertainment industry figures, often giving their first or only interview on breaking news stories on his show. After broadcasting his CNN show from 9 to 10 p.m., King then traveled to
8586-490: The outcomes in sepsis. Current professional recommendations include a number of actions ("bundles") to be followed as soon as possible after diagnosis. Within the first three hours, someone with sepsis should have received antibiotics, and intravenous fluids if there is evidence of either low blood pressure or other evidence for inadequate blood supply to organs (as evidenced by a raised level of lactate); blood cultures also should be obtained within this time period. After six hours
8692-408: The person's clinical response or stopped altogether if an infection is not present to decrease the chances that the person is infected with multiple drug resistance organisms. In case of people having a high risk of being infected with multiple drug resistant organisms such as Pseudomonas aeruginosa , Acinetobacter baumannii , the addition of an antibiotic specific to the gram-negative organism
8798-427: The predominant cause of sepsis from the 1960s to the 1980s. After the 1980s, gram-positive bacteria, most commonly staphylococci , are thought to cause more than 50% of cases of sepsis. Other commonly implicated bacteria include Streptococcus pyogenes , Escherichia coli , Pseudomonas aeruginosa , and Klebsiella species. Fungal sepsis accounts for approximately 5% of severe sepsis and septic shock cases;
8904-401: The presence of an infection. Previously, SIRS criteria had been used to define sepsis. If the SIRS criteria are negative, it is very unlikely the person has sepsis; if it is positive, there is just a moderate probability that the person has sepsis. According to SIRS, there were different levels of sepsis: sepsis, severe sepsis, and septic shock. The definition of SIRS is shown below: In 2016
9010-457: The procedure. In the early 1980s, King took human growth hormone daily. After describing himself as a Jewish agnostic in 2005, he stated that he was fully atheist in 2015. In 2017, he told The Jerusalem Post , "I love being Jewish, am proud of my Jewishness, and I love Israel ". In 2019, King sued Nate Holzapfel , a Shark Tank contestant and entrepreneur, alleging that he had misrepresented himself and his reasons for filming
9116-755: The qSOFA criteria are met. The SOFA score was intended to be used in the intensive care unit (ICU) where it is administered upon admission to the ICU and then repeated every 48 hours, whereas the qSOFA could be used outside the ICU. Some advantages of the qSOFA score are that it can be administered quickly and does not require labs. However, the American College of Chest Physicians (CHEST) raised concerns that qSOFA and SOFA criteria may lead to delayed diagnosis of serious infection, leading to delayed treatment. Although SIRS criteria can be too sensitive and not specific enough in identifying sepsis, SOFA also has its limitations and
9222-448: The rate of death in newborns and adults with sepsis. Evidence for the use of IgM -enriched polyclonal preparations of IVIG is inconsistent. On the other hand, the use of antithrombin to treat disseminated intravascular coagulation is also not useful. Meanwhile, the blood purification technique (such as hemoperfusion , plasma filtration, and coupled plasma filtration adsorption) to remove inflammatory mediators and bacterial toxins from
9328-425: The required dose of vasopressor, epinephrine may be added. Epinephrine is not often used as a first-line treatment for hypotensive shock because it reduces blood flow to the abdominal organs and increases lactate levels. Vasopressin can be used in septic shock because studies have shown that there is a relative deficiency of vasopressin when shock continues for 24 to 48 hours. However, vasopressin reduces blood flow to
9434-571: The show. On June 29, 2010, King announced that after 25 years, he would be stepping down as the show's host. However, he stated that he would remain with CNN to host occasional specials. The announcement came in the wake of speculation that CNN had approached Piers Morgan , the British television personality and journalist, as King's primetime replacement, which was confirmed that September. The final edition of Larry King Live aired on December 16, 2010. The show concluded with his last thoughts and
9540-458: The skin and one through each vascular access device (such as an IV catheter) that has been in place more than 48 hours. Bacteria are present in the blood in only about 30% of cases. Another possible method of detection is by polymerase chain reaction . If other sources of infection are suspected, cultures of these sources, such as urine, cerebrospinal fluid, wounds, or respiratory secretions, also should be obtained, as long as this does not delay
9646-782: The studios of the Mutual Broadcasting System to do his radio show, when both shows still aired. Two of his best-remembered interviews involved political figures. In 1992, billionaire Ross Perot announced his presidential bid on the show. In 1993, a debate between Al Gore and Perot became CNN's most-watched segment until 2015. Unlike many interviewers, King had a direct, non-confrontational approach. His reputation for asking easy, open-ended questions made him attractive to important figures who wanted to state their position while avoiding being challenged on contentious topics. King said that when interviewing authors, he did not read their books in advance, so that he would not know more than his audience. Throughout his career, King interviewed many of
9752-690: The timely administration of fluids and antibiotics , the management of sepsis also involves surgical drainage of infected fluid collections and appropriate support for organ dysfunction. This may include hemodialysis in kidney failure , mechanical ventilation in lung dysfunction, transfusion of blood products , and drug and fluid therapy for circulatory failure. Ensuring adequate nutrition—preferably by enteral feeding , but if necessary, by parenteral nutrition —is important during prolonged illness. Medication to prevent deep vein thrombosis and gastric ulcers also may be used. Two sets of blood cultures (aerobic and anaerobic) are recommended without delaying
9858-823: The tissues. Dobutamine is not used as often as epinephrine due to its associated side effects, which include reducing blood flow to the gut. Additionally, dobutamine increases the cardiac output by abnormally increasing the heart rate. The use of steroids in sepsis is controversial. Studies do not give a clear picture as to whether and when glucocorticoids should be used. The 2016 Surviving Sepsis Campaign recommends low dose hydrocortisone only if both intravenous fluids and vasopressors are not able to adequately treat septic shock. The 2021 Surviving Sepsis Campaign recommends IV corticosteroids for adults with septic shock who have an ongoing requirement for vasopressor therapy. A 2019 Cochrane review found low-quality evidence of benefit, as did two 2019 reviews. During critical illness,
9964-495: The underlying clotting abnormalities before a planned surgical procedure. However, platelet transfusion is suggested for platelet counts below (10 × 10 /L) without any risk of bleeding, or (20 × 10 /L) with high risk of bleeding, or (50 × 10 /L) with active bleeding, before a planned surgery or an invasive procedure. IV immunoglobulin is not recommended because its beneficial effects are uncertain. Monoclonal and polyclonal preparations of intravenous immunoglobulin (IVIG) do not lower
10070-484: The use of EGDT is still considered reasonable. Neonatal sepsis can be difficult to diagnose as newborns may be asymptomatic. If a newborn shows signs and symptoms suggestive of sepsis, antibiotics are immediately started and are either changed to target a specific organism identified by diagnostic testing or discontinued after an infectious cause for the symptoms has been ruled out. Despite early intervention, death occurs in 13% of children who develop septic shock, with
10176-436: The use of antibiotics. Within six hours, if blood pressure remains low despite initial fluid resuscitation of 30 mL/kg, or if initial lactate is ≥ four mmol/L (36 mg/dL), central venous pressure and central venous oxygen saturation should be measured. Lactate should be re-measured if the initial lactate was elevated. Evidence for point of care lactate measurement over usual methods of measurement, however,
10282-417: The use of the procalcitonin level as a method to distinguish sepsis from non-infectious causes of SIRS. The same review found the sensitivity of the test to be 77% and the specificity to be 79%. The authors suggested that procalcitonin may serve as a helpful diagnostic marker for sepsis, but cautioned that its level alone does not definitively make the diagnosis. More current literature recommends utilizing
10388-499: The western time zones carried the Open Phone America portion of the show live, followed by the guest interview on tape delay. Some of King's regular callers used pseudonyms or were given nicknames by King, such as "The Numbers Guy", "The Chair", "The Portland Laugher", "The Miami Derelict", and "The Scandal Scooper". At the beginning, the show had 28 affiliates, but eventually rose to over 500. King occasionally entertained
10494-532: Was a growing media market with openings for inexperienced broadcasters. King went to Miami . After initial setbacks, he gained his first job in radio at a small station, WAHR (now WMBM ), in Miami Beach , hired him to clean up and perform miscellaneous tasks. When one of the station's announcers abruptly quit, King was put on the air. His first broadcast was on May 1, 1957, working as the disc jockey from 9 a.m. to noon. He also did two afternoon newscasts and
10600-478: Was born and raised in New York City to Jewish parents who immigrated to the United States from what is now Belarus in the 1920s. He studied at Lafayette High School , a public high school in Brooklyn. He was a WMBM radio interviewer in the Miami area in the 1950s and 1960s and beginning in 1978, gained national prominence as host of The Larry King Show , an all-night nationwide call-in radio program heard over
10706-594: Was born in Minsk in the Russian Empire in present-day Belarus , and Aaron Edward Zeiger, a restaurant owner and defense-plant worker who was born in Pinsk (also in modern-day Belarus). During his early childhood, the family lived at 208 Howard Avenue, a rowhouse in a section of the borough alternatively characterized as part of Bedford–Stuyvesant, Brooklyn , Brownsville or Ocean Hill . King attended Lafayette High School ,
10812-499: Was broadcast live Monday through Friday from midnight to 5:30 a.m. Eastern Time. King would interview a guest for the first hour, with callers asking questions that continued the interview for the next two hours. At 3 a.m., the Open Phone America segment began, where he allowed callers to discuss any topic they pleased with him, until the end of the program when he expressed his own political opinions. Many stations in
10918-579: Was dropped when the newspaper redesigned its "Life" section. The column was resurrected in blog form in November 2008 and on Twitter in April 2009. During his career, King conducted more than 60,000 interviews. CNN's Larry King Live became "the longest-running television show hosted by the same person, on the same network and in the same time slot", and was recognized for it by the Guinness Book of World Records . He retired in 2010 after taping 6,000 episodes of
11024-520: Was found to reduce mortality from 46.5% to 30.5% in those with sepsis, and the Surviving Sepsis Campaign has been recommending its use. However, three more recent large randomized control trials (ProCESS, ARISE, and ProMISe), did not demonstrate a 90-day mortality benefit of early goal-directed therapy when compared to standard therapy in severe sepsis. It is likely that some parts of EGDT are more important than others. Following these trials
11130-480: Was frequently seen behind home plate at the team's games. He was part of an investment group that attempted to bring a Major League Baseball franchise to Buffalo, New York , in 1990. He lost $ 2.8 million to Bernie Madoff . In 2009, 2011, and several times in 2015, King said that he would like to be cryonically suspended . He discussed the issue with his family two years before his death, and "after much consideration," he decided that he did not want to undergo
11236-571: Was hospitalized with COVID-19 at the Cedars-Sinai hospital in Los Angeles . King recovered from the virus, but died on January 23 from sepsis at the age of 87. King was born in Brooklyn , New York City, on November 19, 1933. His parents were Orthodox Jews who immigrated to the United States from Soviet Belarus in the 1920s. He was one of two sons of Jennie (née Gitlitz), a garment worker who
#671328