Systemic Inflammatory Response Syndrome
From WardWiki - Foundation Doctor Helper
Systemic Inflammatory Response Syndrome is defined by the Society of Critical Care Medicine as two of the following:
1. Core Temperature less than 36°C or greater than 38°C..................................consider blood cultures and antibiotics
2. Heart rate greater than 90 beats per minute..................................................consider ABG and ECG
3. Tachypnoea (high respiratory rate), with greater than 20 breaths per minute....consider ABG
4. White blood cell count less than 4 or greater than 12....................................consider blood cultures and antibiotics
Note that blood pressure does not appear above and it certainly does present later than tachycardia. Take a serum lactate if shock or sepsis is suspected. A low white blood cell count is a sign of immune collapse and a worrying sign
Sepsis is defined as evidence of infection in the presence of SIRS. The peripheral pulses are bounding due to vasodilation that causes shunting.
Severe sepsis occurs when sepsis leads to organ dysfunction through hypotension and or DIC. It presents as oliguria, confusion, raised serum lactate, falling wcc without clinical improvement, hyperglycaemia and other organ failure. Always take a clotting screen in patients with severe sepsis. While high output cardiac failure can be a sequala of sepsis note that troponin can leach from inflamed myocardium in sepsis without myocardial infarction.
SIRS without infection is seen in acute pancreatitis, acute respiratory distress syndrome, anaphylaxis and pulmonary embolism.
SIRS is not a diagnosis in itself but is useful in highlighting a patient is unwell, requires resusitation and may need escalation of care to a critical care unit.
Culture blood and any sputum, urine, drain fluid and blood from venous cannulae ( not recently sited ones) before the first dose of antibiotics. Ensure the patient is well filled with fluids as vasodilation is seen in sepsis.
