• Question 1
A 47 year old male admitted with an infected elbow wound. On his second day in the hospital you find him in hisÂ
room confused and agitated.
Vital signs are as follows:
Temperature – 96.2 °F
Pulse -140 beats per minute
Respirations – 40 breaths per minute
Blood Pressure – 90/40 mmHg
Labs include a WBC count of 3,000
Pt weighs 185 pounds
Further assessment of him includes:
• Urine output of 100cc for the last 8 hours
• Pulse oximetry of 88% on room air
• Pallor
What is your working diagnosis?
Corre
ct
Answ
er:
There are 4 stages of sepsis.
Systemic InflammatoryÂ
Response SyndromeÂ
(SIRS)
Sepsis Severe Sepsis Septic Shock
Criteria – any 2 of theÂ
following:
*Temperature over 100.9Â
or less than 96.8
*Heart rate over 90
*Respirations over 20 perÂ
minute
*WBC over 12,000 orÂ
less than 4,000
Meet SIRS criteria andÂ
have a possible orÂ
documented source ofÂ
infection
*positive cultures orÂ
possible infection site
Sepsis criteria plusÂ
evidence of organ systemÂ
dysfunction
*new need for invasive orÂ
non-invasive respiratoryÂ
intervention
*BP less than 90 systolic,Â
MAP less than 65, orÂ
Systolic BP 40 mmHgÂ
less than previousÂ
documented BP
*New altered mentalÂ
status
*Cr greater than 2 orÂ
urine output less thanÂ
0.5cc/kg/hour for 2 hours
*Plateletssless thanÂ
100,000
*Lactate greater than 2Â
mm/L
Severe sepsis criteria plusÂ
any one of the following:
*Tissue hypoperfusionÂ
persists despiteÂ
crystalloid fluidÂ
administered.
*need for vasopressorsÂ
documented by BP lessÂ
than 90 systolic, MAPÂ
less than 65, or SystolicÂ
BP 40 mmHg less thanÂ
previous documented BP
* Lactate greater than 4Â
mm/L