A PRACTICAL APPROACH TO DIAGNOSING MANAGING THE SEPTIC PATIENT

摘要

Sepsis is a challenging clinical syndrome that leads to some of the most critical patients we treat. Early in the course of disease, symptoms can be relatively subtle, but without prompt and aggressive medical and often surgical treatment the prognosis is extremely poor. Our focus today is on finding practical and efficient ways to diagnose and treat septic patients to improve the outcome wherever possible. The first step is in recognizing and identifying the septic focus, which in some cases is veryobvious, and in others is much more of a challenge. Sepsis is defined as a suspected or proven infection plus a systemic inflammatory response syndrome (e.g., fever, tachycardia, tachypnea, and leukocytosis). If the patient is also showing signs of organ dysfunction (e.g., hypotension, hypoxemia, oliguria, thrombocytopenia, obtundation), we define this as severe sepsis. The most critical of these progressions is to septic shock, which is when you have a patient in severe sepsis with hypotension that isunresponsive to fluid therapy. Obviously our hope is to catch the symptoms before the condition progresses to septic shock and multiorgan dysfunction, although every patient's presentation will be slightly different.