From SIRS to Septic Shock
SIRS/Sepsis
What you see:
• Temp < 36 C or > 38 C
• HR > 90 bpm
• RR > 20 bpm or pCO2 < 32
mmHG
• WBC < 4,000 or > 12,000
• Patient will feel unwell and
look somewhat sick, hot, and
diaphoretic
What is happening:
• Infection is no longer localized
• Systemic response to
circulating cytokins, toxins,
TNF, etc results in
vasodilation and decreased
end organ
perfusion/oxygenation: body
responds by increasing RR
and HR to compensate for this
• Metabolic demands increasing
• May have mild metabolic
acidosis
What needs to be done:
• ABC’s- may need O2 therapy
• Inform the physician team
• VS q2-4H, H2T assessment
• Blood, urine, sputum cultures
• Make sure the IV’s are at least
20G and patent
• Serum lactate, CBC, renal
profile, CBG’s
• Prepare for antimicrobials
• Keep patient/family informed
Severe Sepsis Septic Shock
What you see: What you see:
• Hypotension is a SBP < 90 mmHG or a MAP of • Ongoing and profound
<60 mmHg
hypotension despite fluid and
• Hyperglycemia in the absence of diabetes
• Altered mental state antimicrobial administration
• Hypoxemia, 02 sat < 92% • Profound metabolic acidosis
• Acute oliguria < 0.5 ml/kg/hr • Decreasing LOC or coma
• Coagulopathy, INR >1.5, PTT > 60s, or platelets • Risk of losing airway
< 100
• Serum Lactate > 2 mmol/L (some literature says • Patient looks awful, pale, cool,
4 mmol/L). edematous, and unresponsive
• Patient looks really sick and feels horrible, may
be cool to touch now
What is happening: What is happening:
• Inflammatory mediators • Patient’s compensatory
continue to be produced mechanisms are overwhelmed
• Coagulation cascade now • Out-of-control
systemic inflammatory/immune reaction to
• Further decrease in CO, infection.
oxygenation, and blood • Multiple organ failure in progress
shunting away from most • Metabolic demands extremely
organs high
• Capillary leakage worsening, • Unable to maintain
metabolic acidosis airway/oxygenation needs
• Compensatory mechanisms • Refractory vasodilation
fully taxed • Clotting factors used up, patient
• Profound systemic may bleed (DIC)
vasodilation
What needs to be done: What needs to be done:
• ABC’s-will need oxygen • Maintain ABC’s, VS q15 mins,
• IV fluid bolus’s, more than one constant O2 sat monitoring
IV site is needed • Assist critical care team as patient
• VS q1h at least is prepared for transfer to ICU
• Serum INR&PTT, liver • Patient may need to be intubated
enzymes, ABG’s, CK, etc on the ward.
• H2T assessment q4h, focused • Give accurate and thorough report
assessments of CVS/Resp to ICU RN
q1H • Notify patient/family members of
• Insert foley catheter, monitor transfer
urine output q1H
• Keep patient/family informed