(1)
Royal Free NHS Foundation Trust, London, UK
Sepsis definitions
SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
CRITERIA: Requires two or more of the following:
Temperature >38 C or <36 degrees Centigrade
Heart rate >90 beats/minute in the absence of beta-blocker
Respiratory rate >20 breaths/minute or paCO2<4.2 kPa (32 mmHg)
White blood cell count >12,000/cu.mm, <4000/cu mm or >10% immature forms (left shift)
SEPSIS
SIRS in a patient with a confirmed source of infection
SEVERE SEPSIS
Sepsis in the presence of organ dysfunction and hypotension (<90 mmHg or 40 mmHg reduction from normal blood pressure in the absence of other causes of hypotension)
SEPTIC SHOCK
Sepsis (SIRS + infection) with a systolic blood pressure <90 mmHg or a drop of
>30 mmHg, despite adequate resuscitation and signs of perfusion deficits (i.e. lactic acidosis, oliguria, depressed mental status)
May not be hypotensive if vasopressors or inotropes are being used.
Causes of fever of unknown origin
Infection
Bacterial: tuberculosis; infective endocarditis; liver abscess; perinephric abscess; subphrenic abscess; bone and joint infections
Viral: Epstein Barr virus; AIDS
Chlamydial
Rickettsial
Fungal
Protozoal: amoebic liver abscess
Connective tissue disease: polyarteritis nodosa; systemic lupus erythematosus; Still’s disease; polymyalgia rheumatica; temporal arteritis
Malignancy: lymphoma; leukaemia; solid tumours: renal cell carcinoma; hepatocellular carcinoma
Inflammatory bowel disease
Drug fever
Factitious fever (failure of temperature to follow normal diurnal cycle; health care professional; normal pulse and respiratory rate with fever, rapid defervescence without sweating; very high temperature 106 F or greater)
Fever check list
Localising symptoms
Pattern and duration of fever
Temperature-pulse relationship (relative bradycardia)
Drug history, including intravenous drug use
Travel history
Sexual history
Sick contacts
Animal contacts
Occupational history
Immunisation history
Implanted medical devices and prostheses
Past history of serious, protracted, unusual recurrent infections
Sources of infection in sepsis
Lungs: pneumonia, lung abscess
Cardiovascular system: infective endocarditis
Genitourinary system: urinary tract infection, pyelonephritis
Gastrointestinal system: cholecystitis, diverticulitis, appendicitis, colitis, pelvic abscess
Gynaecological: retained tampon; pelvic inflammatory diseaseRelated posts:
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