Sepsis a syndrome?

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To continue a debate that I am having on another forum...

How would you classify sepsis? Would you classify it as a syndrome, a disease process, or an inflammatory response?

For a little background, it is on an article from JEMS, a prehospital care site, on how sepsis was responsible for over 350,000 deaths in America a year. Some are saying that sepsis is a syndrome. This is what I said...(direct cut and paste. I didn't feel like typing it again.)

And again, I disagree that sepsis is a syndrome. Syndrome, as defined by Stedman's is the combination of signs and symptoms associated with a particular morbid process, which together constitute the picture of disease or inherited anomaly. I can tell you that the medical textbooks and the nursing texts don't classify sepsis as a syndrome. It is an inflammatory response due to untreated bacterial infections. When bacteria enters the blood stream, it sets off the inflammatory response by the releasing of cytokines, which in turn affect the entire vascular system leading to multi-organ failure and cardiovascular collapse.

Here is a link to the article.http://www.jems.com/article/news/sepsis-kills-more-375000-americans-each

The article states that it is an inflammatory response, however I want to know what you think.

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A syndrome is a group of symptoms that consistently occur together or a conditions characterized by a set of associated symptoms. http://www.merriam-webster.com/dictionary/syndrome

So, by definition, yes, sepsis is a syndrome.

Also, by definition on the Mayo Clinic website, sepsis is inflammation triggered by infection. http://www.mayoclinic.com/health/sepsis/DS01004

Sepsis is a complex disease process, in my opinion.

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it's a cascade.

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Specializes in Emergency Nursing.

Sepsis or septicemia is the condition of bacteria being in the bloodstream.

Sudden Inflammatory Response Syndrome is the syndrome that is commonly associated with sepsis, but not always SIRS can be caused by other things too.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

sepsis is a serious medical condition that is characterized by a whole-body inflammatory state. also called systemic inflammatory response syndrome or sirs, and the presence of a known or suspected infection. the body may develop this inflammatory response to microbes in the blood, urine, lungs, skin, or other tissues.

severe sepsis occurs when sepsis leads to organ dysfunction, hypotension, or insufficient blood flow hypoperfusion to one or more organs causing, lactic acidosis, decreased urine production, or altered mental status. sepsis can lead to septic shock, multiple organ dysfunction syndrome, formerly known as multiple organ failure, and death. organ dysfunction results from sepsis-induced hypotension (

i found this from the cleveland clinic....

sepsis, also known as systemic inflammatory response syndrome (sirs), is a serious medical condition caused by the body's response to an infection.

sepsis, also known as systemic inflammatory response syndrome (sirs), is a serious medical condition caused by the body’s response to an infection. sepsis can lead to widespread inflammation and blood clotting. inflammation may result in redness, heat, swelling, pain, and organ dysfunction or failure. blood clotting during sepsis causes reduced blood flow to limbs and vital organs, and can lead to organ failure or gangrene (damage to tissues).

bacterial infections are the most common cause of sepsis. sepsis can also be caused by fungal, parasitic, or viral infections. the source of the infection can be any of a number of places throughout the body. common sites and types of infection that can lead to sepsis include:

  • the abdomen—an inflammation of the appendix (appendicitis), bowel problems, infection of the abdominal cavity (peritonitis), and gallbladder or liver infections
  • the central nervous system—inflammation or infections of the brain or the spinal cord
  • the lungs—infections such as pneumonia
  • the skin—bacteria can enter skin through wounds or skin inflammations, or through the openings made with intravenous (iv) catheters (tubes inserted into the body to administer or drain fluids). conditions such as cellulitis (inflammation of the skin’s connective tissue) can cause sepsis.
  • the urinary tract (kidneys or bladder)—urinary tract infections are especially likely if the patient has a urinary catheter to drain urinehttp://my.clevelandclinic.org/disorders/sepsis/hic_sepsis.aspx

according to the american college of chest physicians and the society of critical care medicine,[2] there are different levels of sepsis:

  • systemic inflammatory response syndrome (sirs). defined by the presence of two or more of the following findings:

    [*]sepsis. defined as sirs in response to a confirmed infectious process. infection can be suspected or proven (by culture, stain, or polymerase chain reaction (pcr)), or a clinical syndrome pathognomonic for infection. specific evidence for infection includes wbcs in normally sterile fluid (such as urine or cerebrospinal fluid (csf)); evidence of a perforated viscus (free air on abdominal x-ray or ct scan; signs of acute peritonitis); abnormal chest x-ray (cxr) consistent with pneumonia (with focal opacification); or petechiae, purpura, or purpura fulminans.

    [*]severe sepsis. defined as sepsis with organ dysfunction, hypoperfusion, or hypotension.

    [*]septic shock. defined as sepsis with refractory arterial hypotension or hypoperfusion abnormalities in spite of adequate fluid resuscitation. signs of systemic hypoperfusion may be either end-organ dysfunction or serum lactate greater than 4 mmol/l. other signs include oliguria and altered mental status. patients are defined as having septic shock if they have sepsis plus hypotension after aggressive fluid resuscitation (typically upwards of 6 liters or 40 ml/kg of crystalloid solution)

    [*]http://en.wikipedia.org/wiki/sepsis

systemic inflammatory response syndrome or sirs is evidence of the body's ongoing inflammatory response. when sirs is suspected or known to be caused by an infection, this is sepsis. severe sepsis occurs when sepsis leads to organ dysfunction, such as trouble breathing, coagulation or other blood abnormalities, decreased urine production, or altered mental status. if the organ dysfunction of severe sepsis is low blood pressure (hypotension), or insufficient blood flow (hypoperfusion) to one or more organs (causing, for example, lactic acidosis), this is septic shock.

http://en.wikipedia.org/wiki/systemic_inflammatory_response_syndrome

maybe not the answer you were looking for but i hope this helps..:)

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Esme, thanks for the information.

All replies help. I was just wondering what other people thought. I enjoy the discussion.

When I went through Paramedic school, not a whole lot was devoted to patho. Most have been taught "cookbook medicine" as in you have this and this, so you do this and that and go here. My education, we were always taught to think about why we are doing what we are doing and how our patient got to that point in the first place, but still not everyone knows a lot about the WHY. I have always wanted to know and to improve my knowledge base.

Going through nursing school, I not only built on what I knew as a Paramedic, but I learned a great deal more. I think we should always learn and adapt or change our thinking to the better. When I received a patient with something I didn't understand, I always tried to talk to the doctors, nurses and then do the research.

I still have a great deal to learn.

Thanks for the discussion.

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Specializes in ICU.

We recently had a pt diagnosed with "septic shock syndrome," which sounded odd to me. But Esme's info makes sense.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

there is also tss or toxic shock syndrome

toxic shock syndrome (tss) is a potentially fatal illness caused by a bacterial toxin. different bacterial toxins may cause toxic shock syndrome, depending on the situation. the causative bacteria include staphylococcus aureus and streptococcus pyogenes. streptococcal tss is sometimes referred to as toxic shock-like syndrome (tsls) or streptococcal toxic shock syndrome (stss).

http://en.wikipedia.org/wiki/toxic_shock_syndrome

toxic shock syndrome

disease listing | general information | technical information | additional information

clinical featurestoxic shock syndrome (tss) is characterized by sudden onset of fever, chills, vomiting, diarrhea, muscle aches and rash. it can rapidly progress to severe and intractable hypotension and multisystem dysfunction. desquamation, particularly on the palms and soles can occur 1-2 weeks after onset of the illness. etiologic agentusually exotoxin producing strains of staphylococcus aureus, a bacterium.incidencein the united states, annual incidence is 1-2/100,000 women 15-44 years of age (last active surveillance done in 1987).sequelae5% of all cases are fatal. transmissions. aureus commonly colonizes skin and mucous membranes in humans. tss has been associated with use of tampons and intralady partsl contraceptive devices in women and occurs as a complication of skin abscesses or surgery. risk groupsmenstruating women, women using barrier contraceptive devices, persons who have undergone nasal surgery, and persons with postoperative staphylococcal wound infections.surveillancenational surveillance is conducted through the national electronic telecommunications system for surveillance (netss). the last active surveillance was in 1987 in four states with a total population of 12 million. challengesto describe the current epidemiology of tss in the united states by conducting active surveillance. to better define the risk factors of nonmenstrual tss to design prevention strategies.

septic shock has a specific definition requiring several criteria for diagnosis:

  • first, sirs (systemic inflammatory response syndrome) must be met by finding at least any two of the following:

tachypnea (high respiratory rate) > 20 breaths per minute, or on blood gas, a pco2 less than 32 mmhg signifying hyperventilation.white blood cell count either significantly low, 12000 cells/mm³.heart rate > 90 beats per minutetemperature: fever > 38.5 °c (101.3 °f) or hypothermia

  • second, there must be sepsis and not an alternative form cause of sirs. sepsis requires evidence of infection, which may include positive blood culture, signs of pneumonia on chest x-ray, or other radiologic or laboratory evidence of infection
  • third, signs of end-organ dysfunction are required such as renal failure, liver dysfunction, changes in mental status, or elevated serum lactate.
  • finally, septic shock is diagnosed if there is refractory hypotension (low blood pressure that does not respond to treatment). this signifies that intravenous fluid administration alone is insufficient to maintain a patient's blood pressure from becoming hypotensive.
  • http://en.wikipedia.org/wiki/septic_shock

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Specializes in Critical Care, Progressive Care.
Sepsis or septicemia is the condition of bacteria being in the bloodstream.

Sudden Inflammatory Response Syndrome is the syndrome that is commonly associated with sepsis, but not always SIRS can be caused by other things too.

ScottE - i think you are close, but not quite right.

Sepis may be septicemia, but not always. Sepsis is Systemic Inflammatory Response Syndrome (SIRS) in the presence of a known infection. If the infection the infection is a blood infection then it is septicemia, if not, it is sepsis. Sepsis, therefore, may be present in the absence of a blood infection .

So in answer to the OP, sepsis is syndrome (SIRS) with and infection.

I would also add, that whether you call it a syndrome, a disease, or rat's orifice, it is a very nasty thing that is fortunately survivable is diagnosed and treated early.

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bah, adminsiter meds as ordered....move on :)

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Sepis may be septicemia, but not always.

If you really want to break it down...

seps/o means infection

-emia means condition involving the blood

-sepsis means putrification which if you think about is what basically happens.

Again, thanks for the discussion. I am learning a lot.

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bah, adminsiter meds as ordered....move on :)

I feel that it is extremely important to understand the disease process that you are just "administering meds as ordered" on. If you don't, you have no way of knowing WHY your patient is being treated the way they are being treated. You also will not have a clue as to why you are giving a specific med, and if maybe that med just might not be a good idea. You might also not realize when your patient is actually getting worse instead of better.

Part of the job as a Nurse is being their advocate, it is the same as when I was a Paramedic. It is something that I take very seriously. How are you able to advocate for your patient if you have your head up a hole and don't have a clue as to what might be going on with your patient?

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