Identify and discuss sepsis, SIRS, severe sepsis, and septic shock by listing the diagnostic criteria for each SIRS, Severe Sepsis, and Septic Shock

 

Sepsis is regarded as a potentially life-threatening condition caused by the body’s response to an infection. SIRS (systemic inflammatory response syndrome) is a clinical syndrome characterized by a systemic inflammatory response to a variety of insults, including infection, trauma, surgery, and burns. As per Chiu and Legrand (2021), severe sepsis is a complication of sepsis that occurs when there is organ dysfunction, hypoperfusion, or hypotension in addition to the signs of sepsis. Septic shock is a life-threatening condition that occurs when severe sepsis is accompanied by persistent hypotension despite adequate fluid resuscitation.

The diagnostic criteria for sepsis and SIRS include

  • Fever (temperature > 38°C) or hypothermia (temperature < 36°C).
  • Heart rate > 90 beats per minute.
  • Respiratory rate > 20 breaths per minute or arterial carbon dioxide tension (PaCO2) < 32 mmHg.
  • White blood cell (WBC) count > 12,000 cells/mm3, < 4,000 cells/mm3, or > 10% immature (band) forms.
  • The diagnostic criteria for SIRS are:
  • Two or more of the following signs of systemic inflammation:
  • Fever (temperature > 38°C) or hypothermia (temperature < 36°C).

In severe sepsis, the diagnostic criteria include;

  • Signs of sepsis/SIRS
  • Evidence of organ dysfunction, hypoperfusion, or hypotension, which may include:
  • Acute alteration in mental status.
  • Acute respiratory distress syndrome (ARDS).
  • Acute renal failure.
  • Coagulation abnormalities.
  • Liver dysfunction.
  • Cardiovascular instability.

The diagnostic criteria for septic shock are:

  • Signs of sepsis (two or more of the SIRS criteria).
  • Evidence of organ dysfunction, hypoperfusion, or hypotension, as in severe sepsis.
  • Persistent hypotension (systolic blood pressure < 90 mmHg, mean arterial pressure < 65 mmHg, or a decrease in systolic blood pressure of > 40 mmHg from baseline) despite adequate fluid resuscitation.

The sepsis protocol in my workplace includes sepsis screening, diagnostic testing, early administration of antibiotics, fluid resuscitation, hemodynamic support, source control, and monitoring and reassessment. One of the newest approaches to sepsis management is using immunomodulatory therapies. Immunomodulatory therapies aim to modify the immune response to infection, which is often dysregulated in sepsis.

 

For example, intravenous immunoglobulins (IVIG) are a pooled product of immunoglobulins derived from human plasma that can modulate the immune response by neutralizing toxins and proinflammatory cytokines (Wulff et al., 2019).

Fever can lead to dehydration and electrolyte imbalances due to increased evaporative water loss, metabolic demands, and decreased intake of fluids and electrolytes. Nonpharmacological and nutritional interventions for managing fever and associated conditions in the adult gerontology population include fluid and electrolyte replacement, cooling measures, nutritional support, rest and sleep, and monitoring for complications (Usman et al., 2019).

In summary, these conditions should be diagnosed and treated promptly because sepsis and septic shock can lead to organ failure and death if left untreated. Treatment usually involves the administration of broad-spectrum antibiotics, fluids, and supportive care.

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