Sepsis
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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
- Systemic inflammatory response syndrome (SIRS) criteria
- 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
- Sepsis-induced hypotension present?
- 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
- Differential diagnosis
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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
- Systemic inflammatory response syndrome (SIRS) criteria
- 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
- Sepsis-induced hypotension present?
- 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
- Differential diagnosis
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