Sepsis
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Basics
Description
- Presence of an infection with an associated systemic inflammatory response
- The systemic inflammatory response syndrome (SIRS) is composed of 4 criteria:
- Temperature >38°C or <36°C
- Heart rate >90 bpm
- Respiratory rate >20/min or PaCO2 <32 mm Hg
- WBC >12,000/mm3, <4,000/mm3, or >10% bands
- Sepsis = suspected infection with ≥2 SIRS criteria:
- Release of chemical messengers by the inflammatory response
- Macrocirculatory failure through decreased cardiac output or decreased perfusion pressure
- Microcirculatory failure through impaired vascular autoregulatory mechanisms and functional shunting of oxygen
- Cytopathic hypoxia and mitochondrial dysfunction
- Hemodynamic changes result from the inflammatory response:
- Elevated cardiac output in response to vasodilatation
- Later myocardial depression
- Multiple organ dysfunction syndrome (MODS):
- Acute respiratory distress syndrome (ARDS)
- Acute tubular necrosis and kidney failure
- Hepatic injury and failure
- Disseminated intravascular coagulation
- Sepsis should be viewed as a continuum of severity from a proinflammatory response to organ dysfunction and tissue hypoperfusion:
- Severe sepsis: Sepsis with at least 1 of the following organ dysfunctions:
- Acidosis
- Renal dysfunction
- Acute change in mental status
- Pulmonary dysfunction
- Hypotension
- Thrombocytopenia or coagulopathy
- Liver dysfunction
- Septic shock: Sepsis-induced hypotension despite fluid resuscitation:
- Systolic BP <90 mm Hg or reduction of >40 mm Hg from baseline
- Severe sepsis: Sepsis with at least 1 of the following organ dysfunctions:
- Sepsis is the tenth leading cause of death in the U.S.:
- In-hospital mortality for septic shock is ∼20%
Etiology
- Gram-negative bacteria most common:
- Escherichia coli
- Pseudomonas aeruginosa
- Rickettsiae
- Legionella spp.
- Gram-positive bacteria:
- Enterococcus spp.
- Staphylococcus aureus
- Streptococcus pneumoniae
- Fungi (Candida species)
- Viruses
Pediatric Considerations
- Children with a minor infection may have many of the findings of SIRS
- Major causes of pediatric bacterial sepsis:
- Neisseria meningitidis
- Streptococcal pneumonia
- Haemophilus influenzae
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Basics
Description
- Presence of an infection with an associated systemic inflammatory response
- The systemic inflammatory response syndrome (SIRS) is composed of 4 criteria:
- Temperature >38°C or <36°C
- Heart rate >90 bpm
- Respiratory rate >20/min or PaCO2 <32 mm Hg
- WBC >12,000/mm3, <4,000/mm3, or >10% bands
- Sepsis = suspected infection with ≥2 SIRS criteria:
- Release of chemical messengers by the inflammatory response
- Macrocirculatory failure through decreased cardiac output or decreased perfusion pressure
- Microcirculatory failure through impaired vascular autoregulatory mechanisms and functional shunting of oxygen
- Cytopathic hypoxia and mitochondrial dysfunction
- Hemodynamic changes result from the inflammatory response:
- Elevated cardiac output in response to vasodilatation
- Later myocardial depression
- Multiple organ dysfunction syndrome (MODS):
- Acute respiratory distress syndrome (ARDS)
- Acute tubular necrosis and kidney failure
- Hepatic injury and failure
- Disseminated intravascular coagulation
- Sepsis should be viewed as a continuum of severity from a proinflammatory response to organ dysfunction and tissue hypoperfusion:
- Severe sepsis: Sepsis with at least 1 of the following organ dysfunctions:
- Acidosis
- Renal dysfunction
- Acute change in mental status
- Pulmonary dysfunction
- Hypotension
- Thrombocytopenia or coagulopathy
- Liver dysfunction
- Septic shock: Sepsis-induced hypotension despite fluid resuscitation:
- Systolic BP <90 mm Hg or reduction of >40 mm Hg from baseline
- Severe sepsis: Sepsis with at least 1 of the following organ dysfunctions:
- Sepsis is the tenth leading cause of death in the U.S.:
- In-hospital mortality for septic shock is ∼20%
Etiology
- Gram-negative bacteria most common:
- Escherichia coli
- Pseudomonas aeruginosa
- Rickettsiae
- Legionella spp.
- Gram-positive bacteria:
- Enterococcus spp.
- Staphylococcus aureus
- Streptococcus pneumoniae
- Fungi (Candida species)
- Viruses
Pediatric Considerations
- Children with a minor infection may have many of the findings of SIRS
- Major causes of pediatric bacterial sepsis:
- Neisseria meningitidis
- Streptococcal pneumonia
- Haemophilus influenzae
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