First Things First (assess & treat for the following)

• IF A PT IS IN SHOCK, RESUSCITATE & SUSTAIN THE ABCs FIRST, THEN ASCERTAIN THE ETIOLOGY AFTER TREATMENT IS INITIATED!
• Sepsis is the leading cause of death in noncardiac ICUs.
• Does pt have sepsis?
  • Systemic inflammatory response syndrome (SIRS) criteria
    • Temperature: >38C or < 36C
    • Heart rate: >90 beats/min
    • Respiratory rate: >20 breaths/min or PaCO2 < 32 mmHg
    • WBC: >12,000 or < 4,000 cells/mm3
  • Two or more criteria = SIRS
  • SIRS caused by infection = sepsis
• Does pt have septic shock?
  • Sepsis-induced hypotension present?
    • SBP < 90 mmHg or MAP < 60 mmHg
  • No response to fluid resuscitation or requirement of vasopressors to maintain BP
  • Perfusion abnormalities present
    • Lactic acidosis
    • Oliguria
    • Altered mental status
• Is multiple organ dysfunction syndrome (MODS) present?
  • Cr >1.5 mg/dL
  • Elevated AST, ALT, alk phos, or bilirubin
  • Heart failure
  • Respiratory failure
  • Mental status changes
• SIRS may progress to MODS in the absence of infection.
  • Differential diagnosis
    • MI, PE, pancreatitis, burns, anaphylactic reaction, toxic shock syndrome, drug overdose or poisoning, hypothermia, delirium tremens, transfusion reaction, cardiac tamponade, UGI bleed, acute adrenal insufficiency