SIRS and Sepsis Flashcards
Sepsis definition
A life-threatening syndrome that arises when the body’s response to infection injures its own tissues and organs
Septic shock definition
A subset of sepsis characterized by persistent hypotension despite adequate fluid resuscitation and inadequate tissue perfusion resulting in tissue hypoxia
(highest mortality over severe sepsis, sepsis, and SIRS)
3 key goals to responding to sepsis
- Early recognition
- Early Tx with antibiotics and IV fluids
- Appropriate escalation to high-acuity or ICU
What does SIRS stand for?
Systemic inflammatory response syndrome
What is SIRS?
- An exaggerated defense response of the body to a stressor (infection, trauma, acute inflation, lack of BF, malignancy, etc.)
- Can lead to reversible or irreversible organ disfunction and even death
- Marked by a high P, low BP or high T, abnormal WBC count, altered LOC
- pre-sepsis criteria
When to suspect sepsis
If a Pt has 2 or more SIRS criteria and a source of infection
P > 90
RR > 20
T ≥ 38 or < 36
WBC outside of 4.0-12.0 x 10^9/L
Altered LOC
Examples of suspected sources of infection
- R: cough/sputum/chest pain/SOB
- GI: ab pain/distention/V&D
- GU: dysuria/frequency/indwelling catheter
- IN: skin or joint pain/swelling/erythema/mottled skin/ cold extremities
- central line present
4 Key Interventions if yes to 2 SIRS criteria and a suspected source of infection
- Labs and diagnostics
- Antibiotics
- IV fluids boluses
- Monitoring
What is included in Labs and diagnostics
- blood cultures!
- lactate! (anaerobic metabolism)
- CBC (complete blood count)
- electrolytes
- metabolic
- glucose level
- inflammatory marker
- chest x-ray
- wound culture
- sterile urine sample
What increases risk of sepsis?
- very young or very old
- autoimmune diseases
- lowered immune systems
- immunosuppressant drugs (like for organ transplants)
- comorbidities
- diabetes
- heart disease
- invasive devices
Define sepsis
Where the body’s response to infection damages its tissues and organs. Can be a life-threatening condition if it isn’t recognized early or treated properly
2 defining characteristics of Septic Shock
- Severe sepsis with hypotension that does not resolve despite IV fluid resuscitation
- Lactate ≥ 2.0 mmol/L
(Septic shock = sepsis + persistent hypotension)
What to check prior to and following each fluid bolus
Repeat vitals and auscultate chest. Contact MD if deterioration b/c of or despite IV fluids.
How long should you wait before giving antibiotics?
Wait 30 mins for blood culture to give antibiotics unless pt is crashing, then give broad spectrum
How much IV bolus do you give?
Typically 30 ml/kg of NS or ringer’s lactate within the first 3 hours. Ensure at least a 20 gauge IV is in place and start a second IV as necessary.
What do you monitor for?
- Vital signs: QH for 6 hours, then Q4H for 12 hours after that
- GCS: QH for 6 hours
When to call MD and ICU outreach team?
RR outside of 10-30
O2 < 90%
P outside 40-140
systolic BP < 90
sudden LOC changes
urine output < 25ml/hour
Why is urine output important?
Kidneys are end organs, blood is taken away from less vital organs for the heart, brain, and lungs when body is in stress. Less BF to kidneys = less urine. Organ perfusion can be measured by hour on u/o.
What are vasopressors?
Vasopressors squeeze BVs to raise BP to give blood to non vital organs. Needs to be given by a central line.
Ex. Norepinephrine, vasopressin
What is MODS
Multiple Organ Dysfunction Syndrome:
Identified failure of critical organ function in patients that have sustained sepsis.
How many patients who survive severe sepsis live past 5 years?
61%
Define severe sepsis
Sepsis associated with organ dysfunction, hypoperfusion (reduced BF), or hypotension
