Sepsis

Sepsis is a topic covered in the Pocket ICU Management.

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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

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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

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Last updated: May 3, 2010