SIRS

Systemic Inflammatory Response Syndrome (SIRS) - is an inflammatory state affecting the whole body, frequently a response of the immune system to infection.

SIRS is a serious condition related to systemic inflammation, organ dysfunction, and organ failure. It is a subset of cytokine storm, in which there is abnormal regulation of various cytokines. SIRS is also closely related to sepsis, in which patients satisfy criteria for SIRS and have a suspected or proven infection

Criteria for SIRS are

• Body temperature less than 36°C or greater than 38°C
• Heart rate greater than 90 beats per minute
• Tachypnea (high respiratory rate), with greater than 20 breaths per minute; or, an arterial partial pressure of carbon dioxide less than 4.3 kPa (32 mmHg)
• White blood cell count less than 4000 cells/mm³ (4 x 10⁹ cells/L) or greater than 12,000 cells/mm³ (12 x 10⁹ cells/L); or the presence of greater than 10% immature neutrophils (band forms)

SIRS can be diagnosed when two or more of these criteria are present

Fever and leukocytosis are features of the acute-phase reaction, while tachycardia is often the initial sign of hemodynamic compromise. Tachypnea may be related to the increased metabolic stress due to infection and inflammation, but may also be an ominous sign of inadequate perfusion resulting in the onset of anaerobic cellular metabolism.

Complication of SIRS
SIRS is frequently complicated by failure of one or more organs or organ systems. The complications of SIRS include:

• Acute lung injury
• Acute kidney injury
• Shock
• Multiple organ dysfunction syndrome
  

Some other terms that we need to noe and differentiate it :

i) Sepsis = SIRS + known@suspected infection @ SIRS + Bacteremia

ii) Septicemia = presence of bacteria in blood(bacteremia) + severe infection with septic sign*

iii) Septic Shock = reduce tissue perfusion and reduced O2 delivery due to infection and sepsis and the MAIN criterias are 1- evidence of infection ( +ve blood culture) 2-refractory hypotension ( hypo despite adequate fluid resuscitation...BP<90..wbc>12000 ... 3-HR>90 ... 4-temp>38C ... 5-cold peripheries

iv) Severe Shock = septic shock + MODs(multiple organ dysfx) and not recovering despite treatment

Management of Septic Shock
[OVERS]

1 Oxygen therapy - put the patient with Nasal prog or FaceMask or Ventimask
2.Volume resuscitation - set 2 large branula (16G) and run fluid thru it
3.Early antibiotics - wide spectrum antibitics IV
4,Rapid sauce identification - and wound infected or do a septic workour asap
5.Support for major org dysfx - monitor patient vital sign .. brain, heart, kidney, lung, liver, intestine..