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Sepsis: Systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS)

Video transcript

when you hear the term sepsis or septic you might be thinking of sewage in fact that's what comes to my mind septic tank and it's not so much that you have sewage in the body it's more that you have an infection or something that causes inflammation in the bloodstream your blood is normally clean and doesn't have any infective material in it but in septic shock that's kind of the issue that's what causes septic shock septic shock is shock decreased tissue perfusion decreased oxygenation of the tissues and low blood pressure hypotension which is caused by some sort of infection or inflammation now septic shock is really part of a greater category known as sepsis and I'm going to have to get into some nitty-gritty detail here so you can understand a categorization of septic shock and really it's just sepsis is a spectrum you start with more mild symptoms and you progress to more severe symptoms and at the more severe end of this spectrum is septic shock so let's go ahead and start it out the first category that fits into this sepsis picture is known as sirs si RS and that stands for systemic inflammatory response syndrome now the name of that itself systemic inflammatory response suggests that this is in response to something that's inflammatory diets it's in the name inflammatory response but it does not necessarily mean that there's an infection to meet sirs criteria a patient must satisfy two or more of the four following signs or symptoms first of all having a temperature above 38 degrees Celsius so that's a hundred point five degrees Fahrenheit or having a temperature less than 36 degrees Celsius which is ninety six point eight degrees Fahrenheit now to give you an idea of what's normal normal body temperature is 37 degrees Celsius or 98.7 degrees Fahrenheit so this is about what patient will have if they have a normal temperature so being very feverish or being very cold and clammy can be a part of sirs criteria the next criteria is a heart rate above 90 now notice normally when you think of a rapid heart rate tachycardia which is a fast heartbeat that's said to be above a hundred but for service criteria it only has to be above 90 next respiratory rate is above 20 or the paco2 the partial pressure of carbon dioxide in the body is less than 32 so either one of these will satisfy one criteria so so far we have temperature heart rate and respiratory rate rapid breathing as three criteria of sirs systemic inflammatory response syndrome now really quickly paco2 is normally 40s than thirty-two is because your breathing rapidly so you're expelling off carbon dioxide and of course a normal respiratory rate is around 12 to 15 the final criteria of sirs is white blood cells and if you have greater than 12,000 or less than 4,000 then this meets sirs criteria think of it this way either your body is responding appropriately and ramping up the amount of white blood cells immune cells in the body or more dangerous whatever infective material such as maybe bacteria or virus in your body is winning the battle and there are less white blood cells available also if you see greater than 10% banned cells that can fulfill the criteria and also ban cells are just young immune white blood cells so the idea is you have a lot of white blood cells that need to be produced rapidly so the body is trying to create white blood cells quickly but instead all it has is these young immature pan cells and so it releases them because better to have something to be able to fight this war against this infection that's going on in the blood now remember these are just really merely clinical clues that could suggest widespread inflammation I mean if you go for a jog or go for a run you already fulfill two of these four criteria right you'll have your heart rate up and your respiratory rate up as well so really keep it in mind keep the clinical picture in mind when you're thinking of sirs criteria next on this spectrum is the category sepsis so sepsis is just sirs the systemic inflammatory response syndrome with a confirmed infection and sepsis is considered more severe if a patient is showing symptoms of organ it problems organ damage or organ dysfunction so for example a patient who's breathing rapidly having difficulty breathing could have damaged lung tissue or a patient with severe abdominal pain might have a bowel perforation or intestinal issues or maybe a patient is having a low urine output that shows damage to the kidney so looking out for organ damage is how you would determine the severity of sepsis septic shock is the next step it's sepsis plus hypotension that just does not go away and what I mean by it does not go away I mean the health practitioner is giving fluids and hypotension still is not going away and I want to make a point here adequate fluid repletion is 30 milliliters per kilogram so you take the patient's weight into account so for example a patient who weighs 50 kilograms you would give 1500 milliliters as quickly as possible and if the blood pressure does not go up with this fluid challenge then the patient is in shock last of all on the most severe end of sepsis of the sepsis spectrum is M o D this stands for multiple organ dysfunction syndrome multiple organ dysfunction syndrome is when a patient has severe septic shock with organ failure now I know that I said at the more severe end of sepsis there I said there would be or in dysfunction you know you'd have difficulty breathing gastrointestinal ischemia decreased oxygenation of the intestines causing GI perforations and maybe kidney damage as well causing decreased urination but a lot of times in severe sepsis this organ dysfunction can be recovered in M ODS it's essentially beyond the state of being able to recover and also in multi organ dysfunction syndrome the liver begins to fail and if the liver begins to fail it cannot clear out toxins that the body has so the infective material the bacteria or whatever infection is in the blood can no longer be cleared out effectively by the liver and the body just completely shuts down and so with sepsis you want to catch it as early as possible so that it does not progress to more severe septic shock or multi organ dysfunction syndrome when all the organs begin to shut down