This is the podcast Surgery. I see Rounds. My name is Jeff Guy. I'm an associate professor of surgery and director of the Burns Center at Vanderbilt University Medical Center. The topic that I want to talk about today is severe sepsis and septic shock. It's a topic that gets thrown around a lot in intensive care unit when we refer to somebody who would say that they septic and often a patient may not be septic we have a very specific guidelines as to what defines

sepsis and septic shock at a patient severe sepsis is the 10th leading cause of death in the

United States and in non-coronary care units it is the leading cause of death.

How we define sepsis has been debated for quite some time and a variety of organizations

have tried to, if we can't define it, well at least try to agree on what we are referring to

septic and septic shock. This started back in 1991 when the American College of Chess Physicians

and decided for critical care medicine developed a consensus conference

for definitions of sepsis and organ failure as well as guidelines for treatment of sepsis.

And from that conference they developed a definition for something we call systemic

inflammatory response syndrome, or SERS, as well as sepsis and septic shock.

We've all heard this silly analogy that it's not the fall, that kills you from falling out of a plane,

but it's a sudden stop.

It's very much the same way in sepsis, is that in many patients it's not the actual infection

of the pneumonia or the bacteriomia or the parotinitis that kills them, but it's how the body

responds to that infection, that the body responds by upregulating a massive inflammatory response,

and that's what really results in the patient's demise in

multi-organ failure.

Now, SERS, which is a systemic inflammatory response syndrome, was initially defined back

in 1991 when a patient had two of the four following criteria.

A temperature greater than 38 degrees centigrade or less than 36 degrees centigrade, a heart rate greater than 90 beats per minute,

hyperventilation at a respiratory rate, an adult greater than 20 breaths per minute, or an arterial

PCO2 of lower than 32 millinators of mercury, or a white count greater than 12,000 or lower than 4,000.

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