Term
| A 52 yr old man presents to the ER with a fever of 39, HR 130, BP 100/60, and WBC of 13,500. He is somnolent and unable to provide an accurate review of systems. In addition to providing early goal-directed therapy that includes IVF and antibiotics, what should you obtain? |
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Definition
Find the source:
CXR, UA, Urine culture, blood culture |
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Term
| What is the criteria for SIRS? |
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Definition
Temperature: <36 or >38
HR: >100
RR: >20
Leukocytes: >12,000 OR<4000 OR >10% Bands |
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Term
| What is the DDX of sepsis? |
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Definition
| Cellulitis, necrotizing fasciitis, meningitis, sinusitis, pneumonia, endocarditis, UTI, or GI infections. |
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Term
| What does hypo-perfusion look like? |
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Definition
| cool, pale extremities, decreased pulse, AMS, decreased urine output. |
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Term
| What is the DDX of hypo-perfusion? |
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Definition
| MI, Cardiac tambonade, acute pancreatitis, acute hemorrhage, transfusion rxn, drug rxn, anaphylaxis, acute adrenal insufficiency, myxedema coma. |
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Term
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Definition
Find the focus of infection
CXR, UA, urine and blood cultures, CBC, BMP, Glucose, lactate, AST, ALT, aPTT, PT and ABG if resp failure is a concern.
Consider TEE, peritoneal fluid sample, pleural fluid, sputum, CSF and US all foreign bodies (catheter, IV, Pacemaker |
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Term
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Definition
Rapid fluid resuscitation
Appropriate transfusions, possible central like for high-volume, pressors, inotropes
Arterial like for BP monitoring
broad spectrum abx while waiting for sensitivities of cultures.
IF pt meets criteria for severe sepsis or septic shock and has multiorgan failure or ARDS, consider starting activated protein C. |
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Term
| What is the criteria for sepsis? |
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Definition
| Two criteria for SIRS with evidence of infection. |
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Term
| What is the criteria for severe sepsis? |
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Definition
| Sepsis with end organ damage |
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Term
| What is the criteria for septic shock? |
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Definition
| Sepsis with BP not responding to fluids alone, needing pressors and/or inotropes. |
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