Patho:

Presence of a systemic inflammatory response to documented or presumed infection, which may

progress along a continuum. Unknown organism enters bloodstream releasing toxic substances
into the bloodstream.

i. Systemic inflammatory response syndrome (SIRS)

1. Infection with release of endo- or exotoxins activating the inflammatory cascade—

local release of cytokines 
into the circulation in attempt to restore homeostasis



2. Failure of mechanism leads to destructive response 
with loss of circulatory integrity.




3. Criteria (two or more)—fever higher than 
100.4°F/38°C or lower than 96°F/36°C;

heart rate greater than 90 beats per minute; respiration greater than 20/min or
PaCO2 less than 32 mm Torr; white blood cell (WBC) count greater than 12,000,
less than 4000, or greater than 10% of bands or immature cells 


ii. Severe sepsis—presence of known or suspected infection and two or more SIRS criteria;
associated with organ dysfunction, hypoperfusion, hypotension with alteration of mental
status, hypoxemia, lactic acidosis, and/or oliguria 


iii. Septic shock—characterized by hemodynamic changes and persistent hypotension,

development of perfusion abnormalities, and impaired cellular function that fails to
respond to adequate fluid resuscitation 


iv. Multiple organ dysfunction syndrome (MODS)—organ dysfunction leading to organ

failure with inability to maintain homeostasis 


Nandas: