Page 237 - Critical Care Notes

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Clinical Presentation
■ Temp >38°C (100.4°F) or <36°C (96.8°F)
■ HR >90 bpm
■ RR >20 bpm or Paco 2 <32 mm Hg
■ WBC >12,000/mm 3 , <4,000/mm 3 , or >10% immature (band) forms
■ Fever and chills
■ Fatigue and malaise
■ Warm and pink skin, progressing to cold, clammy, and mottled skin
■ Significant edema or positive fluid balance (>20 mL/kg over 24 hr)
■ Hypotension or normal BP. SBP <90 mm Hg or SBP decrease >40 mm Hg,
MAP <70 mm Hg
■ Widening pulse pressure
■ ↓ right atrial pressure (RAP) and left ventricular stroke work index (LVSWI)
■ Pao 2 /FIO 2 ratio <300
■ ↑ lactate levels and lactic acidosis
■ Decreased urine output progressing to oliguria with ↑ serum creatinine levels
■ Acute changes in mental status, such as anxiety, apprehension, delirium,
disorientation, confusion, combativeness, agitation, lethargy, or coma
■ Increased RR, SOB, crackles, hypoxemia progressing to pulmonary edema,
acute lung injury, hypoxemia, and respiratory failure
■ Nausea, vomiting, jaundice, ↓ GI motility, and ileus
■ Changes in carbohydrate, fat, and glucose metabolism. Hyperglycemia
>140 mg/dL in the absence of diabetes
■ Signs of thrombocytopenia and coagulopathies (possibly progressing to DIC)
■ Possible development of signs of septic shock
Diagnostic Tests
■ CBC with differential (↑ or ↓ WBC)
■ Platelet count
■ Basic metabolic panel, bilirubin (↑), serum lactate (↑), liver function tests
(abnormal), amylase, and protein C (↓)
■ Urinalysis
■ 1,3-beta-D-glucan assay
■ Anti-mannan antibody assays
■ Plasma procalcitonin (PCT)
■ Insulin resistance with elevated blood glucose
■ ABGs (hypoxemia, lactic acidosis)
■ ECG
■ Urine, sputum, wound, and blood cultures
■ Gram-Positive Blood Culture Nucleic Test (BC-GP)
■ Coagulation studies including aPTT (↑), INR (↑), and D-dimer (↑)
■ Imaging studies to confirm source of infection
MULTISYS