Daily Bolus of LR: The continuum of sepsis

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May 18, 2011 by dailybolusoflr

The continuum of sepsis can be a confusing thing.  Let’s define the various stages along the spectrum so that we are all on the same page with the nomenclature and criteria.


Systemic Inflammatory Response Syndrome (SIRS) is a global inflammatory response related to infection, trauma or an inflammatory state.


SIRS criteria are listed below.  The presence of SIRS is noted when any two or more are present.


·         Temperature > 38C (100.4F)  or < 36 C (96.8F)

·         Heart Rate > 90bpm

·         Respiratory Rate > 20 or PaCo2 < 32

·         WBC > 12,000 cells/mm3 or < 4000 cells/mm3


Sepsis is defined as suspected OR proven infection PLUS a Systemic Inflammatory Response Syndrome (SIRS)


Severe sepsis is defined as sepsis with evidence of organ dysfunction (hypotension, hypoxemia, oliguria, metabolic acidosis, thrombocytopenia, AMS)


Septic shock is defined as severe sepsis with hypotension despite adequate volume resuscitation



N Engl J Med 2006;355:1699-713.



Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions


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