1. SEPSIS
Rajat Pareek, MD

2. Pediatric SIRS
Non specific inflammatory changes occuring after trauma, infection, burns, pancreatitis and other diseases.

3. Definition of SIRS
Atleast 2 /4 cirteria, one of which MUST be abnormal Temp/abnormal leucocyte count
Core temp >38.5, < 36
Tachycardia: >2SD above normal for age in absence of external stimulus, chr drugs, painful stimuli/ unexplained persistent elevation over a ½-4hr time frame OR children <1 yr: bradycardia, ie mean HR < 10th% for age in absence of vagal stimulus/B-blocker drugs or CHD/unexplained depression over a ½ hr time period

4. Def. contd
3. Resp rate <2 SD above normal for age or mech ventilation in absence of underlying neuromuscular disease/GA
4. WBC elevated or depressed for age (not due to chemo induced leucopenia) OR >10% immature neutrophils.

5. Definition of INFECTION
A suspected or proven (by Culture, Tissue stain, PCR) infection caused by any pathogen OR
Clinical syndrome asso with high probablity of infection.
Evidence of infection: PE findings, imaging, labs ie CXR, petechial rash, Increased WBCs in sterile body fluids, etc.

6. SIRS + INFECTION= SEPSIS
Definition of SEPSIS
SIRS + INFECTION= SEPSIS

7. Definition of SEVERE SEPSIS+
One of the foll:
1. CV organ dysfunction
2. ARDS
3. >=2 more other organ dysfunction

8. Definition of SEPTIC SHOCK
SEPSIS +
CV ORGAN DYSFUN =
SEPTIC SHOCK

9. Organ Dysfunction CV Dysfunction:
Hypotension < 5th% for age OR SBP < 2SD below normal for age OR
2. Vasoactive drug to maintain BP (dopamine > 5mcg/kg/min or dobutamine/epi/norepi at any dose)
2 of the foll:
Unexplained metabolic acidosis: base deficit >5
Increased art lactate >2 times upper limit of normal
Oliguria: UO < 0.5ml/kg/hr
Cap refill >5 sec
Core to peripheral temp gap > 3C

10. Organ Dysfunction
Respiratory Dysfunction
PaO2/FiO2 <300 in absence of CHD/Pre existing lung disease OR
PaCO2 > 65 torr or 20 mm Hg over baseline PaCO2 3.