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Four definitions you must know:

  1. SIRS – Must have at least 2 of 4 SIRS criteria (listed below):
    • Fever (>38C) or Hypothermia (<36C)
    • WBC >12k or <4k ; OR Bandemia >10%
    • Tachycardia > 90
    • Tachypnea > 20
  2. SEPSIS – Must have SIRS + have a suspected infectious source (eg pulmonary, urinary, intra-abdominal, etc)
  3. SEVERE SEPSIS – Must have Sepsis + ONE of the following criteria indicative of end organ dysfunction:
    • Hypotension (MAP<65 or SBP<90)
    • Creatinine > 2.0 (with normal baseline renal function)
    • Lactate > 2.0
    • Platelets < 100k
    • INR > 1.5
    • Bilirubin > 2
  4. SEPTIC SHOCK – Must have severe sepsis PLUS one of the following
    • Hypotension DESPITE adequate fluid resuscitation (usually 30cc/kg bolus)
    • Lactate > 4.0 DESPITE adequate fluid resuscitation (usually 30cc/kg bolus)

GENERAL GUIDELINES (exact management depends on clinical scenario):

  • If patient meets SIRS criteria you work the patient up for sepsis / severe sepsis:
    • Lactate, Blood Cultures, Urinalysis/Culture, Chest XRay
    • CBC, BMP, Coags, LFTs
  • If patient meets SEPSIS criteria, you add in broad spectrum antibiotics +/- intravenous fluids
  • If patient meets SEVERE SEPSIS criteria, you give a 30cc/kg fluid bolus,
  • If patient meets SEPTIC SHOCK criteria and is HYPOTENSIVE, you start vasopressors (norepinephrine usually)

MDCalc – Sepsis

Sepsis-2 and Sepsis-3 Guidelines Summarized