21.6: Appendix F - SIRS AND SEPSIS

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Sepsis is an infection that leads to a systemic inflammatory response resulting in physiologic changes occurring at the capillary endothelial level. This systemic inflammatory response is referred to as Systemic Inflammatory Response Syndrome or SIRS.

Based on severity, there are three sepsis syndromes:
1. Sepsis. SIRS in the setting of an infection.
2. Severe sepsis. An infection with end-organ dysfunction as a result of hypoperfusion, the reduced delivery of nutrients and oxygen to tissues and organs via the blood.
3. Septic shock. Severe sepsis with persistent hypotension and tissue hypoperfusion despite fluid resuscitation.

A diagnosis of SIRS can generally be made when a patient exhibits two or more of the following:

1. A temperature above 100.4° F or below 96.8° F.

2. A heart rate above 90 beats per minute.

3. A respiration rate above 20 breaths per minute or a Pa CO2 below 32 mm Hg.

4. A white blood cell count above 12,000/µL or below 4000/µL.

Other common symptoms include:

hypotension
pulmonary edema
peripheral edema
flushed, warm skin
decreased urine output
decreased bowel sounds
altered mental status
shaking and chills
pain
hyperlactemia and lactic acidosis (Patients with septic shock have lactate levels of more than 5 mmol/L, a lactate-to-pyruvate ratio greater than 10-15:1, and arterial pH of less than 7.35.)

For a tutorial on sepsis, check out the following website: http://faculty.alverno.edu/bowneps/new%20indexes/circindex.html
and click on “Sepsis-What’s Bugging Your Patient” by Linda Bay