Deep Dive - Round 18

Four definitions you must know: * SIRS – Must have at least 2 of 4 SIRS criteria (listed below):* Fever (>38C) or Hypothermia (<36C)* WBC >12k or <4k ; OR Bandemia >10%* Tachycardia > 90* Tachypnea > 20* SEPSIS – Must have SIRS + have a suspected infectious source (eg pulmonary, urinary, intra-abdominal, etc)* SEVERE SEPSIS – Must have Sepsis + ONE of the following criteria indicative of end organ dysfunction:* Hypotension (MAP<65 or SBP<90)* Creatinine > 2.0 (with normal baseline renal function)* Lactate > 2.0* Platelets < 100k* INR > 1.5* Bilirubin > 2* SEPTIC SHOCK – Must have severe sepsis PLUS one of the following* Hypotension DESPITE adequate fluid resuscitation (usually 30cc/kg bolus)* Lactate > 4.0 DESPITE adequate fluid resuscitation (usually 30cc/kg bolus) GENERAL GUIDELINES (exact management depends on clinical scenario): * If patient meets SIRS criteria you work the patient up for sepsis / severe sepsis:* Lactate, Blood Cultures, Urinalysis/Culture, Chest XRay* CBC, BMP, Coags, LFTs* If patient meets SEPSIS criteria, you add in broad spectrum antibiotics +/- intravenous fluids* If patient meets SEVERE SEPSIS criteria, you give a 30cc/kg fluid bolus,* If patient meets SEPTIC SHOCK criteria and is HYPOTENSIVE, you start vasopressors (norepinephrine usually) MDCalc – Sepsis Sepsis-2 and Sepsis-3 Guidelines Summarized