Sepsis/systemic inflammatory response syndrome (SIRS)
Terms in this set (15)
What are the criteria for SIRS?
Two or more of the following conditions:
- temperature > 38°C or <36°C
- pulse > 90 bpm
- respiratory rate > 20 or PaCO2 < 32 mm Hg
- WBC > 12,000/mm3 or <4,000/mm3 (or >10% bands)
What is SIRS?
The systemic response to a wide range of stresses
What is the Quick SOFA (qSOFA)
Has replaced the SIRS scoring system. Use to predict mortality, NOT to diagnose sepsis, per 2017 Surviving Sepsis Guidelines.
What is sepsis?
The systemic response to infection. Includes qSOFA criteria in the setting of suspected or proven infection
What is sepsis syndrome or severe sepsis?
Sepsis with an evidence of altered organ perfusion including at least 1 of the following: hypoxemia, elevated lactic acid, oliguria, or altered mentation
What is septic shock?
Sepsis syndrome and hypotension despite adequate fluid resuscitation attempts, requiring pressors
What are the noninfectious causes of SIRS?
Burns, cardiopulmonary bypass, and pancreatitis
What are the leading bacterial causes of BSI?
Infection with staphylococci and streptococci, followed by infection with E. coli, Enterobacter sp., and Pseudomonas aeruginosa
List the common symptoms and signs of sepsis by bacterial infection.
Fevers, chills, hyperventilation, hyperthermia or hypothermia, changes in mental status, hypotension, bleeding, leukopenia, thrombocytopenia, and organ failure
What are the predisposing factors for sepsis?
Surgery, chemotherapy, trauma, transplantation, and splenectomy
What is the workup for sepsis?
1. Meticulous history and physical examination for clues to the source and extent of an infectious process
2. Microbiologic studies including blood cultures and culture of any potential source of a systemic infection (draw blood cultures before initiating antibiotics)
3. If CNS signs are present, lumbar puncture
What is the antibiotic treatment for sepsis?
Empiric antimicrobial regimens (modified based on culture results) should include broad gram-negative and gram-positive coverage. For nosocomial and neutropenic sepsis, coverage should include activity against Pseudomonas. If an indwelling vascular catheter infection is suspected, vancomycin should be considered.
What supportive therapies should be considered?
Fluid and electrolyte management and sympathomimetic agents (dopamine, dobutamine, and norepinephrine) as needed to maintain adequate blood pressure
Is there a role for empiric steroids in sepsis?
No, controlled clinical trials have failed to confirm any beneficial effects of corticosteroids in septic shock except in patients with adrenal insufficiency.
List the organisms associated with postsplenectomy sepsis.
Encapsulated organisms including S. pneumoniae, H. influenzae, and N. meningitides
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