Tuesday, May 17, 2011

Sepsis in all its Glory

I won't reproduce all of the information I have read about in this article, but rather mention some highlights. For extra info, you can read from my sources.

Bacteremia

Bacteremia is simply the presence of bacteria in the blood. Is measured by taking a blood sample and attempting to culture out any bacteria. Of course, the blood sample should normally be sterile.

Note that the term bacteremia does not imply the existence of any symptoms.

SIRS – Systemic Inflammatory Response Syndrome

Inflammation is of course a normal and necessary immune response to close off an infection and/or wound, and to being the healing process. However, that inflammation can go wrong and go systemic, hence the terms SIRS. SIRS is a clinical diagnosis, and is diagnosed upon meeting 2 of the following 4 criteria:

  • T > 38.5 or T < 35
  • HR > 90
  • RR > 20 or PaCO2 < 32 mmHg
  • WBC < 5000 or WBC > 12,000

And when SIRS is deemed to be secondary to a bacterial infection or bacteremia, it is called sepsis. You may notice that this implies that SIRS can be caused by non-bacterial etiologies, and indeed it can, e.g acute pancreatitis.

What is confusing to me are the 4 criteria for SIRS above. They just seem so non-specific to me. Hopefully they will make sense at some point.

Shock

We had a lecture on Shock from Dr. Goldhaber in Block 9. I'm still going with the definition of shock that it is decreased perfusion of organs that leads to organ damage. So shock, or more specifically septic shock in this discussion, is different from SIRS and sepsis. One may even think of shock as a severe outcome of sepsis. References

1. http://www.uptodate.com/contents/sepsis-and-the-systemic-inflammatory-response-syndrome-definitions-epidemiology-and-prognosis

2. http://www.uptodate.com/contents/pathophysiology-of-sepsis

3. http://en.wikipedia.org/wiki/Septic_shock

4. http://en.wikipedia.org/wiki/Bacteremia

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