Sepsis: Systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS)

Sepsis: Systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS)


– [Voiceover] When you
hear the term sepsis or septic, you might
be thinking of sewage. In fact, that’s what comes
to my mind, septic tank. And it’s not so much that you have sewage in the body, it’s more that you have an infection or something that causes inflammation in the bloodstream. Your blood is normally clean and doesn’t have any infective material in it, but in septic shock,
that’s kind of the issue. That’s what causes septic shock. Septic shock is, shock, decreased tissue perfusion, decreased oxygenation of the tissues, and low blood pressure, hypotension, which is caused by some sort of infection or inflammation. Now, septic shock is really part of a greater category known as sepsis, and I’m going to have to get into some nitty gritty detail here,
so you can understood the categorization of septic shock. Sepsis is really just a spectrum. You start with more mild symptoms, and you progress to more severe symptoms, and at the more severe end of the spectrum is septic shock. So, let’s go ahead and start it out. The first category that fits
into this sepsis picture is known as SIRS, and that stands for Systemic Inflammatory Response Syndrome. Now, the name of that itself, Systemic Inflammatory Response, suggests that this is in response to something
that’s inflammatory. Duh, it’s in the name,
inflammatory response, but it does not necessarily mean
that there’s an infection. To meet SIRS criteria, a
patient must satisfy two or more of the four
following signs or symptoms. First of all, having a
temperature above 38 degrees Celsius, so that’s 100.5
degrees Fahrenheit, or having a temperature
less than 36 degrees Celsius, which is 96.8 degrees Fahrenheit. Now, to give you an idea of what’s normal, normal body temperature is 37 degrees Celsius or 98.7 degrees Fahrenheit, so this is about what a patient will have if they have a normal temperature. So, being very feverish,
or being very cold and clammy, can be a
part of SIRS criteria. The next criteria is
a heart rate above 90. Now, notice, normally when you think of a rapid heart rate,
Tachycardia, which is a fast heartbeat, that’s
said to be above 100, but for SIRS criteria, it
only has to be above 90. Next, respiratory rate is
above 20, or the PaCO2, the partial pressure of carbon dioxide in the body, is less than 32. So, either one of these
will satisfy one criteria. So, so far we have temperature, heart rate and respiratory rate, rapid breathing, as three criteria of SIRS, Systemic Inflammatory Response Syndrome. Now, really quickly, PaCO2 is normally 40. Less than 32 is because
you’re breathing rapidly, so you’re expelling off carbon
dioxide, and, of course, a normal respiratory
rate is around 12 to 15. The final criteria of
SIRS is white blood cells, and if you have greater than 12,000, or less than 4,000, then
this meets SIRS criteria. Think of it this way, either your body is responding appropriately and ramping up the amount of white blood cells, immune cells in the
body, or, more dangerous, whatever infective
material, such as, maybe bacteria or virus in your
body, is winning the battle, and their are less white
blood cells available. Also, if you see greater
than 10 percent band cells, that can fulfill the criterion, also. Band cells are just young,
immune white blood cells, so the idea is you have a
lot of white blood cells that need to be produced
rapidly, so the body is trying to create white
blood cells quickly, but instead, all it has
is these young, immature band cells, and so it
releases them, because, better to have something to
be able to fight this war against this infection
that’s going on in the blood. Now, remember, these are
just really merely clinical clues that could suggest
widespread inflammation. I mean, if you go for
a jog, or go for a run, you already fulfill two of
these four criteria, right? You’ll have your heart rate up and your respiratory rate up, as well. So, really keep it in mind,
keep the clinical picture in mind when you’re
thinking of SIRS criteria. Next on this spectrum
is the category sepsis. So, sepsis is just SIRS,
the Systemic Inflammatory Response Syndrome, with
a confirmed infection. And sepsis is considered more severe if a patient is showing
symptoms of organ problems, organ damage or organ dysfunction. So, for example, a patient
who’s breathing rapidly, having difficulty breathing could have damaged lung tissue, or a patient with severe abdominal pain might have a bowel perforation, or intestinal issues. Or, maybe a patient is
having a low urine output. That shows damage to the kidney. So, looking out for organ damage is how you would determine
the severity of sepsis. Septic shock is the
next step, it’s sepsis, plus hypotension that
just does not go away. And, what I mean by it does not go away, I mean the health
practitioner is giving fluids, and the hypotension’s
still is not going away. And I want to make a point here. Adequate fluid repletion is
30 milliliters per kilogram. So, you take the patient’s
weight into account. So, for example, a patient
who weighs 50 kilograms you would give 1500 milliliters
as quickly as possible. And if the blood pressure
does not go up with this fluid challenge, then
the patient is in shock. Last of all, on the most
severe end of sepsis, of the sepsis spectrum, is MODS. This stands for Multiple
Organ Dysfunction Syndrome. Multiple Organ Dysfunction
Syndrome is when a patient has severe septic
shock with organ failure. Now, I know that I said
at the more severe end of sepsis, I said there
would be organ dysfunction. You’d have difficulty breathing, gastrointestinal ischemia,
decreased oxygenation of the intestines,
causing GI perforations, and maybe kidney damage, as well, causing decreased urination. But, a lot of times in severe sepsis, this organ dysfunction can be recovered. In MODS, it’s essentially beyond the state of being able to recover. And, also in Multi Organ
Dysfunction Syndrome, the liver begins to fail, and
if the liver begins to fail, it cannot clear out the
toxins that the body has. So, the infective material, the bacteria or whatever infection is in the blood, can no longer be cleared out
effectively by the liver, and the body just completely shuts down. And so, with sepsis, you
want to catch it as early as possible so that it does
not progress to more severe septic shock or Multi
Organ Dysfunction Syndrome, when all the organs begin to shut down.

47 thoughts on “Sepsis: Systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS)

  1. Metabolic Theory of Septic Shock
    Please do a search for the above
    Core tip: For decades septic shock has been attributed to an over-active immune response. However, immune modulation has failed to reduce mortality, casting doubt on a direct causal role for the immune response in the development of septic shock. A closer look suggests that septic shock is the result of a generalized build-up of hydrogen peroxide, a toxic cellular by-product generated as a consequence of the hypermetabolic state that accompanies a systemic immune response. This finding points to the systemic accumulation of hydrogen peroxide as a significant risk factor for the development of septic and non-septic shock syndromes.

  2. This was really well explained. I had sepsis but it was caught early, before organ dysfunction, septicaemia or shock. Some people and doctors don't understand because they don't know the difference between sepsis, septic shock, septicaemia and SIRS. 😕

  3. This is an excellent video with very useful information, but it is now already a little dated. As of 2016 the Society of Critical Care Medicine does not endorse the SIRS + Infection = Sepsis criteria anymore. Sepsis is now defined as a "dysregulated host response" or "organ dysfunction" due to an infection. Dysregulated host response or "organ dysfunction" may be manifested as hypotension, increased respiratory rate, altered mental status, low platelets, and decreases kidney and/or liver function tests, The SIRS definition (along with "severe sepsis" and septic shock) is still used in the USA for billing purposes, and we use it to screen every, single, patients
    at the hospital I work at as a registered nurse… Essentially the new definition of sepsis is the old definition of "severe sepsis". Septic shock occurs towards the end of the sepsis continuum, with hypotension present, that is unresponsive to 30mL/kg of IV fluids, and thus requires the administration of vasoconstricting medications (e.g. norepinephrine, epinephrine, dopamine, phenylephrine, etc) to increase the patients blood pressure to to ensure adequate end-organ- perfusion to vital organs. SIRS is extremely "non-specific" for sepsis. You can score or "screen positive" for "sepsis" by merely exercising, or having another condition that causes a flag in any of the criteria in SIRS. Conditions mimicking sepsis with the SIRS criteria may include occult metastatic cancer, autoimmune/inflammatory diseases, GI bleeds, Alcohol Withdrawal, COPD exacerbation, Adrenal crisis, anxiety, or even a routine hospitalized patient. "QSOFA" is a newer screening tool (based off of the larger "SOFA" score) and is used by some institutions instead of SIRS as a screening process for sepsis because it is more "specific" (albeit at the cost of decreased "sensitivity").

    M

  4. Great Video…. One thing I hate about SIRS criteria… is that some idiot decided to implement SIRS >2 assessment eval for Code Sepsis automatically in the hospitals! Its beyond annoying as you stated in the video going for a run would qualify you for Sepsis 😀 Imagine ICU patients…. (Afib, COPD, CHF, etc.) Ughhhhhhhh

  5. Im just trying to keep my mind off him, he was a firefighter, EMT, Truck Driver, Construction Worker and many, many other things. He grew up with adopted parents and his father died when he was 14.. and hes been a quadriplegic for almost my whole life… Since I was about 6 and hes always.. Always been positive.. Not one day have I heard him complain.. He was a big independent survivalist type guy, and he kept being that as much as he could.. He has always been sharp and smart.. Last night he called for me and was asking me the same thing over and over, eventually I did it, and just got him a comfortable as possible.. So I went back to bed.. When I woke up the Aid that comes into help was already here and waiting on another Nurse to look at him and decide weather we need to call 911.. Well as soon as I took a look at him 100% I knew we did, he had snot coming down his nose, and couldn't even notice I was there.. He was completely incoherent and calling for his long passed mother.. I immediately got him to the Hospital and here we are.. He was able to say "Love you" after I said it to him, and he responded to one of his oldest friends when he showed up, but since last night he hasn't said anything, and hes not lucid at all.. He apparently has "sepsis" which is a blood infection..I cant stand the thought of me not being there with him, Ive been there since last night.. I needed to leave to grab things and like I mentioned, I want more then anything to be there for him, but its grueling seeing him like this.. He hates it.. I know it. Hell Who wouldn't.

  6. Stop sepsis
    Around the world I have cured 40 infections. Both viral and bacterial cells pop in response to ½ a minute of High Intensity UltraSound.
    1 H2O+P+US->He+O+E2+X-ray
    Bacteria are copied, and given a minimal cell wall – as the immune systems thinks they are helpful. 3 days later we see body cell damage – and this system shuts down. Once the bacteria are established.
    http://jonsthings.blogspot.co.uk/2018/02/stop-sepsis.html
    Viruses and cancers divide using a single cell method – which requires infected cells to be inflated and hard.
    We apply High Intensity UltraSound to the infected organ – or the lungs, throat and nose for ½ a minute: plus 20 seconds each side of the lower torso. It is remarkable.
    The infection or diabetes is totally gone in 10 seconds. Cancers clear with 1 minute of High Intensity UltraSound. Metformin criminal medicine for 6 years.
    Even HIV clears with ½ a minute of High Intensity UltraSound to each side of the chest. Confirmed and published 2012, so all prescriptions for HIV drugs since then, defective medicine. Patients get cured, and all medical fees back.
    There Dr is struck off – back dated to 2002. When the Moffitt paper on High Intensity UltraSound clearing cancer was published.
    The Dr gets 25 years in high security prison for ever patient they murdered (10,000 each in 15 years), with defective cancer drugs etc..
    So now High Intensity UltraSound clears all infections. And no Sepsis arises – in my personal, direct experience. 10 seconds to a total cure: obvious best medicine. Fungal antibiotics defective, criminal medicine for 6 years.

  7. I had all this 2 yrs ago and many other things i was dieing my family was told i only had about many 2 hours left to live but theu saved me i still dont no how i got it i am very lucky to be alive my left arm side and leg doesnt work right anymore and i had to give up work because of it but thank god to my family who saved me…… if you think anyone has it call 911 or in the UK 999 it could save someone life

  8. Bacteremia

    is the presence of bacteria in the bloodstream. This may be of primary origin (direct entry into the bloodstream via needles, contaminated infusions, catheters, etc.) or secondary (from a primary source of infection through hematogenous or lymphatic dissemination). Most of the time the body itself is able to eliminate them without the infection occurring. as for Septicemia it is more complicated to understand but you can read it more detaily here [https://mltexpo.blogspot.com/2018/04/bacteremia-and-septicemia-what-are.html

  9. This is super helpful ! The way this is drawn and organized and displayed/explained is exactly how I learn best, this is a wonderful teacher! Thank you and please continue to post more of these educational videos for us nursing or healthcare/med students!

  10. I had Sepsis 2 years ago, I was so close not going to ER since I thought it only was a cold or something similar. Turned out I had severe sepsis , if I had not had went I would be dead. When I came there my fever elevated to above 40 c, my oxygen was at 70% and I was puking. Scary stuff. Turned out that I had an abscess in my liver.

  11. Why are all the Khan videos so quiet? The volume is always an issue that makes me want to avoid this channel- any other sound that comes through while watching these videos causes a blast of sound because the volume needs to be cranked so high.

  12. maybe i had sepsis or septicemia weeks ago, my symptoms are chills, fever and vomit, and my leg was swollen twice as big and very red

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