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Septic patient..Part1..Basic definitions






Systemic Inflammatory Response Syndrome (SIRS)
A screening tool to identify patients who are having a systemic response to a stressor (usually an infection)

  • WBC count <4 or >12
  • Temperature <36 C or >38C (<96.8 F or >100.4 F)
  • Respiratory rate >22 or PaCO2 <30
  • Heart rate >90

PEARL- just because someone meets SIRS doesn’t mean its sepsis or worse. A patient with a broken ankle could have most of those SIRS criteria but they don’t have an infection- it’s a screening tool



Sepsis = 2 out of 4 SIRS criteria + known or suspected source of infection


PEARL- Again, just because you meet criteria for sepsis doesn’t mean you get a central line and get admitted to the MICU. Technically if you are febrile and tachycardic from strep pharyngitis then you are septic.



Severe Sepsis- Sepsis + signs of end organ damage

  • Lactate >4 (byproduct of anaerobic metabolism and a marker of global hypoperfusion)
  • Systolic BP <90 after 2 liters of normal saline bolus (OR more than 40 points below the patient’s established outpatient baseline)
  • New onset (or worsening) renal failure
  • Altered mental status
  • Hyperglycemia in a patient who is not diabetic



Septic Shock- Severe sepsis requiring vasopressors



Early Goal Directed Therapy for Severe Sepsis and Septic Shock
Rivers, et al. New England Journal of Medicine. 2001; 345:1368-137
(Full text available for free- google search “rivers sepsis”- read it!)
Criteria: Patients with severe sepsis or septic shock
Main points of protocol- very aggressive fluid resuscitation- intubate if necessary, early initiation of antibiotics



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