Terry White, MBA, BSN

SEPSIS

SIRS

Systemic Inflammatory Response System• SIRS is a widespread inflammatory response to a variety of

severe clinical injuries. This syndrome is clinically indicated by the presence of 2 or more of the following• Temp >38%C or <26%C

• HR > 90/min

• RR > 20/min or PaCO2 <32mm/HG

• WBC >12 or <4, or with > 10% immature band forms

Sepsis

• Sepsis• In sepsis, the clinical signs of SIRS are present together

with the definitive evidence of infection

SEVERE SEPSIS

• Severe Sepsis• Sepsis is considered severe when it is associated with organ

dysfunction, hypoperfusion, or hypotension

• The manifestations of hypoperfusion may include lactic acid, oliguria, and an acute alteration in mental status

SEPTIC SHOCK

• Septic Shock• Is sepsis with hypotension despite adequate fluid replacement

combined with perfusion abnormalities that may include• Lactic acidosis• Oliguria• Acute alteration in mental status

Patients who require inotropic or vassopressor support despite adequate fluid replacement are in septic shock

MODS

• Multiple Organ Dysfunction Syndrome• Refers to the presences of altered organ function in an

acutely ill patient such that homeostasis cannot be maintained without intervention

RISK FACTORS• Extreme age (<1 yr and >65yrs)• Malnutrition• Hypothermia• Use of Central line catheters• Endotracheal intubation/mechanical ventilation• Aspiration• Chronic illness (Diabetes, RF, Hepatic failure)• Immunodeficiency (AIDS, Alcoholism, chemo)• Use of surgical/invasive procedures

TREATMENT

• POSSIBLE TREATMENTS• Fluid replacement• Control of blood pressure• Tissue perfusion• Early treatment with antibiotics• Administration of steroids for adrenal insufficiency• Control of glucose levels• Protective lung ventilation• Administration of activated protein C