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Chapter 26: Sepsis Syndromes

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Select the definition that describes a patient with septic shock.

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a. GH has the presence of bacteria within the blood.

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b. HH has a systemic inflammatory response to a clinical insult.

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c. JA has an infection associated with organ dysfunction.

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d. KS has an infection with persistent hypotension despite fluid resuscitation.

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Answer d is correct. Septic shock is defined as sepsis with persistent hypotension despite fluid resuscitation. The American College of Chest Physicians and the Society of Critical Care Medicine developed definitions related to sepsis. Physiologic parameters categorize patients as having bacteremia, infection, systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, and multiple-organ dysfunction syndrome (MODS).

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Answer a is incorrect. Bacteremia (or fungemia) is the presence of viable bacteria (or fungi) within the bloodstream.

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Answer b is incorrect. Systemic inflammatory response syndrome (SIRS) is defined as a systemic inflammatory response to a variety of clinical insults that can be either infectious or non-infectious.

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Answer c is incorrect. Severe sepsis is sepsis associated with organ dysfunction,

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YU is a 41-year-old woman admitted to the intensive care unit with possible sepsis secondary to pneumonia. Her vital signs are temperature 38.1°C, heart rate 80 beats/min, and a respiratory rate 16 breaths/min. She also has a white blood cell count of 15,500 cells/mm3. Based on this information, does YU have sepsis?

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a. Yes, YU has sepsis because she has an infection source but meets no SIRS criteria.

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b. Yes, YU has sepsis because she has an infection source and meets two SIRS criteria.

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c. No, YU does not have sepsis because she has an infection source but does not have any organ failure.

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d. No, YU does not have sepsis because she does not have positive cultures.

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Answer b is correct. YU has sepsis because of the infection source (pulmonary), and meets two SIRS criteria (elevated temperature and leukocytosis).

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Answer a is incorrect. The patient has sepsis because she has an infection source (likely pulmonary), but meets two SIRS criteria (elevated temperature and leukocytosis).

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Answer c is incorrect. YU does have sepsis. Organ failure is not a criteria for the diagnosis of sepsis.

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Answer d is incorrect. The patient does have sepsis. Positive cultures are typically not available when patients initially present with sepsis. They are therefore not included in diagnostic criteria for sepsis. Instead, possible loci of infection are determined based ...

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