Justice
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A 75-year-old female nursing-home resident is brought to the emergency department because of a 2-day history of generalized weakness and fever. The patient requires a chronic indwelling urinary catheter.
On physical examination, temperature is 38.4°C (101.1 °F), pulse rate is 95/min, respiration rate is 22/mm, and blood pressure is 132/72 mm Hg. Examination findings are otherwise normal for a patient of her age. The leukocyte count is 13,000/μL (with 11% immature band forms). Urinalysis shows 20-25 leukocytes/hpf. A complete metabolic profile is normal. Arterial oxygen saturation is 95% by pulse oximetry with the patient breathing room air. Urine culture and two sets of blood cultures obtained in the emergency department are growing Escherichia coli.
Which of the following terms best describes this patient’s illness?
A. Systemic inflammatory response syndrome
B. Septic shock
C. Bacteremia
D. Sepsis
E. Severe sepsis
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| nyimalay
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D?
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| dr.wad
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D
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| aim
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whats the difference between these
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| arlete
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C
Edited by arlete on 03/30/08 - 09:18 AM
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| ganesha123
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D
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| kleovoulos
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Bacteremia+S.I.R.S= Sepsis ....
....D, probably.
just wondering why not E?
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| nyimalay
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Bacteremia: Bacterial multipication in blood, no systemic inflammatory response
Sepsis: Signs of systemic inflammatory response (Fever, Tachycardia, Leucocytosis) + source of infection
Severe sepsis: Sepsis + low blood pressure
Septic shock: Sepsis + feature of shock (oliguria, reduced sensorium etc)
SIRS: Shock + features of multiple end organ damage
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| liliaeliz
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D
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| Justice
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The correct answer is D
Although this patient has documented bacteremia (defined as bacteria present in the blood and confirmed by culture), she also has evidence of a systemic response to infection (fever, tachycardia, tachypnea, and an elevated leukocyte count with immature band forms). She does not have organ dysfunction or perfusion abnormalities, which occur in patients with severe sepsis or septic shock. Therefore, the term that best defines her illness is sepsis. The American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Consensus Conference definitions of systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome are as follows:
Systemic inflammatory response syndrome (SIRS): The systemic inflammatory response to a wide variety of severe clinical insults, manifested by at least two of the following conditions: temperature greater than 38.0 °C (100.4 °F) or less than 36.0 °C (96.8 °F), heart rate greater than 90/mm, respiration rate greater than 20/mm or arterial blood Pco2 less than 32 mm Hg, leukocyte count greater than 12,000/μL or less than 4000/μL or with greater than 10% immature band forms.
Sepsis: The systemic inflammatory response to a documented infection. In association with infection, manifestations of sepsis are the same as those described for SIRS.
Severe sepsis: Sepsis associated with organ dysfunction, hypoperfusion, or hypotension.
Septic shock: A subset of severe sepsis, defined as sepsis-induced hypotension despite adequate fluid resuscitation plus the presence of perfusion abnormalities. Patients receiving inotropic or vasopressor agents may no longer be hypotensive by the time they develop hypoperfusion abnormalities or organ dysfunction; however, they would still be considered to have septic shock.
Multiple organ dysfunction syndrome (MODS): Presence of altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention.
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| kleovoulos
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thankx justice for the detailed explanation! this is a commonly tested topic( at least in grounds of school electives) and despite having gone through it so many times I always tend to forget the distinctive details..
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