approach to sepsis for medical students

1. Septic syndromes
SIRS, SEPSIS AND SEPTIC SHOCK
Dr Wail Eldukali

2. OBJECTIVES
• To understand the definitions of SIRS, sepsis
and septic shock and how to differentiate
between them
• To assess the severity of sepsis
• To diagnose septic shock
• To Save Lives by acting fast

3. Outlines Of The Presentation
• Definitions of infection, SIRS and sepsis
• Propagation of infection to sepsis
• Clinical tools to identify sepsis
• Septic shock
• General measures to treat sepsis
• What if is not sepsis !

4. Infection
• Infection is the invasion of an organism's
body tissues by disease-causing agents, their
multiplication, and the reaction of host tissues to the
infectious agents and the toxins they produce
• The process begins with infection in one part of the
body that triggers a localised inflammatory response
• Appropriate source control and a competent
immune system will, in most cases, contain the
infection at this stage.

5. Cardinal Manifestation Of
Inflammation

6. Propagation Of Infection To Sepsis
If certain factors are present ;the host response to
infection become systemic:
• a genetic predisposition to sepsis
• a large microbiological load
• high virulence of the organism
• delay in source control (either surgical or
antimicrobial)
• resistance of the organism to treatment
• patient factors (immune status, nutrition, frailty).

7. Systemic Inflammatory Response
(SIRS)
• The diagnosis of SIRS requires that the patient have at
least two or more of the following clinical
manifestations:
• A body temperature of > 38 °C or < 36 °C
• Heart rate of > 90 beats/minute
• Tachypnea, as manifested by respiratory rate of > 20
breaths/minute or hyperventilation, as indicated by
PaCO2 of < 4.3 kPa
• An alteration of the white blood cell count of > 12 000
cells/mm3, < 4000 cells/mm3, or the presence of > 10%
immature neutrophils (bandforms)

8. Sepsis
• SEPSIS: SIRS occurring in presence of
infection
• Severe sepsis: sepsis with evidence of organ
hypoperfusion, eg hypoxemia,oliguria, lactic
acidosis or altered cerebral function
• Classically patients with sepsis are warm and
vasodilated but may be cold and shut down

9. Septic Shock
• Severe sepsis with hypotension(systolic BP<90
mmHg or MAP <60 mmHg) despite adequate
fluid resuscitation or the requirement for
vasopressors/inotropes to maintain BP
• Sepsis and both of (after fluid resuscitation):
1. Persistent hypotension requiring vasopressors to
maintain a MAP > 65 mmHg
2. Serum lactate > 2 mmol/L (18 mg/dL)

10. Pathophysiology Of Organ Damage In
Sepsis

11. How to recognize sepsis?

12. the Sequential Organ Failure
Assessment (SOFA) score
Patients with suspected infection who have 2 or
more of:
• Hypotension – systolic blood pressure < 100 mmHg
• Altered mental status – Glasgow Coma Scale score
≤ 14
• Tachypnoea – respiratory rate ≥ 22 breaths/min

14. General Measures In Rx Of Sepsis And
Septic Shock
1. Deliver high-flow oxygen
2. Take blood cultures
3. Administer intravenous antibiotics
4. Measure serum lactate and send full blood count
5. Start intravenous fluid replacement
6. Commence accurate measurement of urine
Output
7. Circulatory support

15. Early Administration Of Antibiotics In
Suspected Sepsis
• Broad-spectrum antibiotics should be
administered as soon as possible after sepsis
is suspected
• Every hour of delayed treatment is associated
with a 5–10% increase in mortality

16. Sepsis Mimics
SIRS can result from insults other than sepsis:
• Pancreatitis
• Drug reactions
• Widespread vasculitis – catastrophic antiphospholipid
syndrome, Goodpasture’s syndrome
• Autoimmune diseases – inflammatory bowel disease,
rheumatoid arthritis, systemic lupus erythematosus
• Malignancy – carcinoid syndrome
• Haematological conditions – haemophagocytic syndrome,
diffuse lymphoma, thrombotic thrombocytopenic purpura

17. Sources
• - Davidson’s Principles and practice of
medicine (23rd edition)

18. Home work
1. During your clinical round try to complete full
SOFA score
2. Short assay about {early goal directed
therapy in sepsis}

20. Thank you