Sepsis is a condition that occurs when infectious microorganisms enter the bloodstream. As the numbers of organisms increase, an inflammatory response, called systemic inflammatory response syndrome (SIRS), is triggered due to infection escaping local control. Sepsis presents differently in ED, medicine floor, and ICU patients. A septic patient in the ED will present with: A temperature of above 100.4° F (38° C) or below 96.8° F (36° C); Heart rate of above 90 beats per minute; Respiratory rate of above 20 breaths per minute or a PaCO2 level of less than 32 mm Hg; Elevated white blood cell count >12,000/mm3 (Uffen et al., 2021).
A septic patient on the medicine floor will present with similar clinical manifestations as the ED patient. In addition, they will present with one or more of the following: Hypotension; Reduced urine output compared to fluid intake; Positive fluid balance; Decreased capillary refill; Hyperglycemia above120 mg/dL in the absence of known diabetes; Unexplained change in mental status; Increasing serum creatinine level in a patient with no known history of kidney problems with >2.0 mg/dL in men and >1.4 mg/dL in females (Uffen et al., 2021).
In the ICU, a septic patient will present with decreased oxygen saturation, rapid respiratory rate, decreased to no urine output, and a change in cognition and affect. In addition, the patient presents with clinical manifestations of organ dysfunction, including: Arterial hypoxemia with PaO2/FiO2 <300; Acute oliguria with urine output <0.5 ml/Kg/hr or <45 ml in 2 hours, despite fluid resuscitation; Creatinine increase >44 μmol l−1 in 24 hours; Coagulation abnormalities with INR >1.5 or APTT >60 seconds; Absent bowel sounds; Thrombocytopenia with a platelet count <100,000 μl−1; Hyperbilirubinemia with a plasma total bilirubin >34 μmol l−1; Hyperlactatemia >4 mmol l−1; Decreased capillary refill time (Rababa et al., 2022).
References
Rababa, M., Bani Hamad, D., & Hayajneh, A. A. (2022). Sepsis assessment and management in critically Ill adults: A systematic review. PloS one, 17(7), e0270711. https://doi.org/10.1371/journal.pone.0270711
Uffen, J. W., Oosterheert, J. J., Schweitzer, V. A., Thursky, K., Kaasjager, H. A. H., & Ekkelenkamp, M. B. (2021). Interventions for rapid recognition and treatment of sepsis in the emergency department: a narrative review. Clinical Microbiology and Infection, 27(2), 192-203. https://doi.org/10.1016/j.cmi.2020.02.022
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