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Sepsis

Sepsis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Presence of an infection with an associatedsystemic 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% band forms
  • Sepsis = 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):
    • Adult 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
  • Sepsis is the 10th leading cause of death in US:
    • In-hospital mortality for septic shock is ∼30%

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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Citation

Rosen, Peter, et al., editors. "Sepsis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307613/all/Sepsis.
Sepsis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307613/all/Sepsis. Accessed April 23, 2019.
Sepsis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307613/all/Sepsis
Sepsis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307613/all/Sepsis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Sepsis ID - 307613 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307613/all/Sepsis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -