Sepsis and Systemic Inflammatory Response Syndrome: The Daily PANCE Blueprint

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Sepsis and Systemic Inflammatory Response Syndrome: The Daily PANCE Blueprint

A 76-year-old male with a history of diabetes, CHF (last EF 40%), and CKD presents to the ER with cough, fever, and chills for the past two days. On physical exam, the patient is lethargic and has scattered crackles in the lower right lung. Vitals reveal T 103.3F, BP 132/82 mmHg, HR 132 bpm, RR 24 breaths/min, SPO2 94% on RA. CXR reveals consolation in the right lower lobe. Labs reveal elevated WBC count (15). Lactic acid is unimpressive. What is the most likely diagnosis?

A. Cardiogenic shock
B. Pulmonary embolism
C. Septic shock
D. Sepsis
E. Pneumonia

Answer and topic summary

The answer is D. Sepsis

Sepsis is defined as life-threatening organ dysfunction caused by an inappropriate host response to some sort of infection. It is actually the leading cause of death in adult ICUs. The systemic inflammatory response syndrome (SIRS) criteria are helpful in identifying acute infections. It is defined as the presence of at least 2 of these: Temp > 100.4F or <96.8F, HR >90 bpm, RR >20 breaths/min or PaCO2 <32 mmHg, and WBC > 12K or < 4K. The sensitivity is about 60% so just because they don’t meet the criteria doesn’t mean they don’t have sepsis.

Management includes fluid resuscitation, early antimicrobial therapy, and vasopressor therapy if needed.

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Covered under ⇒ PANCE Blueprint Infectious Disease ⇒ Sepsis/systemic inflammatory response syndrome

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