GIM Question 5 Instructor

What are the criteria for Systemic Inflammatory Response Syndrome (SIRS)?
SIRS is a system-wide inflammatory response to an inciting agent. The criteria for diagnosing SIRS are the presence of 2 or more of the following:

• Temperature >38.5^oC or <35.0^oC
• Heart rate >90 beats/min
• Respiratory rate >20 breaths per minute (or arterial CO₂ tension <32mmhg, or need for mechanical ventilation)
• WBC >12 000/mm³ or <4000/mm³ or >10% band forms

What is the definition of Sepsis? Severe Sepsis?
Sepsis is SIRS caused by a documented infection. Any presentation of SIRS from an unknown etiology should be worked up for an infectious cause to rule out sepsis.

Severe sepsis is sepsis with hypotension (SBP<90, MAP <70)

What is your initial workup and management for a patient with suspected sepsis?
Initial workup:

• CBC, Lytes, Cr, BUN, AST, ALT, ALP
• Serum Lactate (a marker for tissue hypoperfusion)
• Serum glucose (may be elevated in sepsis)
• Urine dip, Urine C&S
• CXR
• Lumbar puncture (consider if suspect meningitis)
• Blood cultures x2 (blood cultures x3 with a new murmur for suspected infectious endocarditis)

Acute management:

• IV NS to maintain BP and prevent shock
• Empiric IV broad-spectrum antibiotics (differnet hospitals may have different protocols). Switch to narrow-spectrum antibiotics once a specific pathogen has been identified
• Treat hyperglycemia (if present) with insulin

Resources

1. Annane D, Bellissant E and Cavaillon JM. Septic shock. Lancet. 2005, 365:63-78.
2. Dellinger R.P. et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Intensive Care Med. 2013; 39:165-228.