{"id":5168,"date":"2011-08-04T16:17:46","date_gmt":"2011-08-04T16:17:46","guid":{"rendered":"http:\/\/crashtext.org\/misc\/sepsis-syndromes.htm\/"},"modified":"2013-09-16T19:01:27","modified_gmt":"2013-09-16T23:01:27","slug":"severe-sepsis","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/resuscitation\/severe-sepsis.htm\/","title":{"rendered":"Severe Sepsis and Septic Shock"},"content":{"rendered":"

<\/span>Best Review<\/span><\/h3>\n

NEJM 2013;369(9):840 Angus et al.<\/p>\n

<\/span>For More Great Evidence and Resources on Sepsis, See our Sepsis Collaborative Page at EMCrit.org<\/a><\/span><\/h2>\n

Review of all current lit (Annals Emerg Med 2006;48(1):28)<\/p>\n

Loma Linda Toolkit<\/a> from
\nNguyen<\/p>\n

ICU Sepsis Screen<\/p>\n

\"\"<\/a><\/p>\n

<\/span>Sepsis Definitions<\/span><\/h2>\n

<\/span>S<\/strong>ystemic I<\/strong>nflammatory R<\/strong>esponse S<\/strong>yndrome (SIRS)<\/span><\/h3>\n

The hallmark clinical manifestations of both sepsis and SIRS are two or more of the following conditions:<\/p>\n

1. Temperature 38\u00baC or 36\u00baC<\/p>\n

(100.4\/96.8)<\/p>\n

2. Tachycardia 90 beats per minute 3. Respiratory rate 20 per minute or a PaCO2 32 mm Hg 4. White blood cell count 12,000 mm3 or 4,000\/mm3 or 10% immature (band) forms (“left shift”). SSC Criteria Infection plus any two, get lactate Temp 101 or 96.5 Altered Mental Status Chills with Rigors Tachy 90 RR 20 WBC 12000 or 4000 Sugar 120 mg\/dl in absence of diabetes signs of severe sepsis, any of the following distinct from the source of infection SBP 90 or MAP 65 or SBP decrease 40 from baseline Cr 2.0 or UO 0.5 cc\/kg\/hour Billi 2 mg\/dl PLT 100,000 Lactate 4 INR 1.4 or PTT 60 bilat infiltrates with criteria for ALI or need for increased supplemental O2 to maintain SpO2 90<\/p>\n

Sepsis<\/h4>\n

2 or more SIRS plus infection<\/p>\n

from the ancient Greeks, who used ?sepsis? to describe putrefaction and a bad smell<\/p>\n

Severe Sepsis<\/h4>\n

Sepsis c organ dysfunction, hypoperfusion, hypotension, AMS, acidosis, oliguria, ARDS<\/p>\n

Septicemia<\/h4>\n

pathogens in the blood stream<\/p>\n

Septic Shock<\/h4>\n

Hypotension after 2L of fluid<\/p>\n

ARDS<\/h4>\n

PaO2\/FiO2 200<\/p>\n

B pulmonary infiltrates<\/p>\n

PAWP 18<\/p>\n

Bone’s criteria define septic shock as systolic BP 90 mm Hg or 40-mm drop in standard BP; organ perfusion based on mean arterial BP, which is determined by diastolic, not systolic, BP; patients whose BP usually 170\/100 mm Hg who present with BP of 110\/60 mm Hg have septic shock (ie<\/em>, 40-mm Hg drop in baseline BP; do not treat with fluids); precipitous drop in mean arterial BP causes change in mental status, hemodynamic embarrassment, renal dysfunction, gastrointestinal (GI) tract hypoperfusion, and liver hypoperfusion (DeBlieux)<\/p>\n

<\/span>Types of Hypoxia<\/span><\/h3>\n

hypoxemic hypoxia (low paO2)<\/p>\n

Anemic Hypoxia<\/p>\n

Stagnant Hypoxia (low CO)<\/p>\n

Cytopathic Hypoxia (Cell machinery can not use O2)<\/p>\n

<\/span>Who has Severe Sepsis?<\/span><\/h2>\n

Infection plus any two, get lactate<\/p>\n