• Question 1

A 47 year old male admitted with an infected elbow wound. On his second day in the hospital you find him in his 

room confused and agitated.

Vital signs are as follows:

Temperature – 96.2 °F

Pulse -140 beats per minute

Respirations – 40 breaths per minute

Blood Pressure – 90/40 mmHg

Labs include a WBC count of 3,000

Pt weighs 185 pounds

Further assessment of him includes:

• Urine output of 100cc for the last 8 hours

• Pulse oximetry of 88% on room air

• Pallor

What is your working diagnosis?

Corre

ct

Answ

er:

There are 4 stages of sepsis.

Systemic Inflammatory 

Response Syndrome 

(SIRS)

Sepsis Severe Sepsis Septic Shock

Criteria – any 2 of the 

following:

*Temperature over 100.9 

or less than 96.8

*Heart rate over 90

*Respirations over 20 per 

minute

*WBC over 12,000 or 

less than 4,000

Meet SIRS criteria and 

have a possible or 

documented source of 

infection

*positive cultures or 

possible infection site

Sepsis criteria plus 

evidence of organ system 

dysfunction

*new need for invasive or 

non-invasive respiratory 

intervention

*BP less than 90 systolic, 

MAP less than 65, or 

Systolic BP 40 mmHg 

less than previous 

documented BP

*New altered mental 

status

*Cr greater than 2 or 

urine output less than 

0.5cc/kg/hour for 2 hours

*Plateletssless than 

100,000

*Lactate greater than 2 

mm/L

Severe sepsis criteria plus 

any one of the following:

*Tissue hypoperfusion 

persists despite 

crystalloid fluid 

administered.

*need for vasopressors 

documented by BP less 

than 90 systolic, MAP 

less than 65, or Systolic 

BP 40 mmHg less than 

previous documented BP

* Lactate greater than 4 

mm/L