Jim Barker

Jim is a 44 year-old man who is admitted with pneumonia. He is short of breath and febrile. He is admitted to the medicine floor after 1g cefriaxone is given IV.

Soon after arriving on the floor, his nurse checks his vitals. His heart rate is 126, blood pressure is 76/42, and his temperature is 39.4. He is delirious at this point.

systemic inflammatory repsonse syndrome - any two of:

• temperature >38 or <36
• HR >90
• resp rate >20 or PaCO2 <32
• WBC >12 or 10% bands

sepsis: SIRS + infection

severe sepsis: sepsis with hypoperfusion, leading to lactic acidosis, oliguria, or altered mental status

septic shock: sepsis-induced hypotension (SBP <90), even with adequate fluid recuscitation

Address ABCs: provide oxygen, ensure adequate IV access, and consider intubation.

Provide agressive fluid recuscitation, with NS 3-10L IV, pentaspan up to 2L, or PRBCs

Provide inotropes:

• levophed 5-50 mg/min
• vasopressin 0.04 U/min
• dopamine 2-50 ug/kg/min

Aim to maintain:

• CVP 8-12 mmHg
• SBP >90, or MAP >65 mmHg
• urine output >0.5 ml/kg/hr
• central venous, or mixed venous, saturation >70%
• normal lactate