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Sepsis: SIRS, Septic Shock, Physical Findings & Labs

by Kevin Pei, MD
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    00:00 Thank you for joining me on this discussion of sepsis in the section of Critical Care. Sepsis is a big topic and a very very expensive healthcare burden particularly towards the end of life.

    00:15 You know back in the medieval days prior to the antibiotics and surgery for source control, patients often died of sepsis. So, let's begin the discussion of defining sepsis. Sepsis is a systemic response to infection in injury. Actually, our homeostatic mechanisms in our body are defensive in nature. Therefore, somewhat argue, the sepsis is actually a normal response that's gone out of control. Unfortunately in sepsis, as a response to infection in injury, the body starts attacking its own normal cells in addition to the infection or site of injury. What are some definitions? Remember, by the time you review this there may have been different iterations of sepsis definitions. The Worldwide Congress on Critical Care change definitions every so often to make sure that it's still compliant and applicable to our patients. Nevertheless, the basics are the same. A patient who is febrile, is tachypneic, who's tachycardic, and has a leukocytosis but very important if you're clinical scenario presents a patient that has a leukopenia or low white blood cell count, it's almost more ominous than an elevated white blood cell count as a low white blood cell count can potentially indicate that the immune system has essentially given up. Now, sepsis definitions is on a continuum but depending on how severe the disease process is affects mortality or death. Sepsis in SIRS with a microbial source pretense with approximately a 16% mortality. That's across U.S. hospitals. In severe sepsis which is defined as sepsis with organ system dysfunction, it's associated with an access of 20% mortality. In the most severe form, septic shock, in which the patient not only demonstrates organ system dysfunction but who has hypotension or low blood pressure that's no longer responsive to fluid resuscitation, these patients have the highest mortality at almost 70%.

    02:32 Remember, any multi-organ system dysfunction means any organ system that requires intervention to maintain homeostasis such as blood pressure or urine output. Let's go on this definition tour of the different stages of sepsis. First, systemic inflammatory response syndrome. SIRS is defined by any of those 2 previous criterion that we defined. When you have SIRS plus organ dysfunction, it's diagnosed as severe sepsis and so concurrently if you have SIRS or systemic inflammatory response and you have a presumed infectious source, that's a definition of sepsis. If the patient continues to progress in severity, sepsis with hypotension equals septic shock. What are some physical findings? As you can imagine, a febrile, tachycardic, tachypneic patient with a leukocytosis probably doesn't look well. It's called at-the-door test, stand at the door of the patient and look in and as a physician you can easily identify somebody who doesn't appear well and maybe in sepsis. Routine laboratories. The chemistries itself may not be helpful, although if the patient has acute kidney injury their creatinine can be elevated. On your CBC, however, you're likely to see a leukocytosis or remember a leukopenia. Additionally, H&H or hemoglobin and hematocrit may be low especially due to a large volume resuscitation. Early on, you may see platelets rise and oftentimes in late severe sepsis, the platelets actually drop or thrombocytopenia.


    About the Lecture

    The lecture Sepsis: SIRS, Septic Shock, Physical Findings & Labs by Kevin Pei, MD is from the course Sepsis.


    Included Quiz Questions

    1. RR > 10 or PACO2< 22mmHg
    2. RR > 20 or PACO2< 32mmHg
    3. WBC > 12,000 or 4,000
    4. HR > 90/min
    5. Temp > 100.4 or < 95.0 F
    1. Hypotension
    2. Shallow breathing
    3. Warm body
    4. Bradycardia
    5. High urine output

    Author of lecture Sepsis: SIRS, Septic Shock, Physical Findings & Labs

     Kevin Pei, MD

    Kevin Pei, MD


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