SIRS and sepsis

• S&S of SIRS and sepsis:

  early stage (SIRS, infection): tachycardia, bounding pulse, fever

  late stage (sepsis, shock): cool pale skin, weak thready pulse, tachycardia, hypotension
• SIRS = systemic inflammatory response syndrome
• SIRS must have the occurrence of at least 2 of the criteria:

  fever greater then 100.4 or below 96.8, tachycardia (more then 90 bpm), tachypnea (more then 20 breaths/minute), leukocytosis or leukopenia
• MEWS = modified early warning score (determines the illness of a patient)
• MEWS is based on blood pressure, heart rate, respiratory rate, temperature, urinary output, alertness
• the HIGHER the MEWS score the more likely the patient will deteriorate and be at risk for death
• SIRS can lead to sepsis then to septic shock
• sepsis is 2 SIRS symptoms and confirmed or suspected infection
• SIRS and sepsis goal: prevent deterioration of hemodynamic status and prevent of septic shock AND stabilize blood pressure and tissue perfusion
• interventions: antibiotics within ONE hour of identification (do all cultures first), fluid boluses (keep circulation up; isotonic fluid), and vasopressors/steroids
• typically as a floor nurse your job ends at giving a fluid bolus and then the patient is transferred to ICU for vasopressors and steroids
• key points:

  early detection saves lives

  cultures (blood, urine, wound) must be done BEFORE antibiotics

  all patients are assessed for SIRS