Fast Five Quiz: Refresh Your Knowledge on Key Aspects of Sepsis

Richard H. Sinert, DO

Disclosures

June 07, 2018

Pay attention to the patient's skin color and temperature. Pallor or grayish or mottled skin are signs of poor tissue perfusion seen in septic shock. In the early stages of sepsis, cardiac output is well maintained or even increased. The vasodilation may result in warm skin, warm extremities, and normal capillary refill (warm shock). As sepsis progresses, stroke volume and cardiac output fall. The patients begin to manifest the signs of poor perfusion, including cool skin, cool extremities, and delayed capillary refill (cold shock).

Fever is a common symptom, though it may be absent in elderly or immunosuppressed patients. The hypothalamus resets in sepsis, so that heat production and heat loss are balanced in favor of a higher temperature. An inquiry should be made about fever onset (abrupt or gradual), duration, and maximal temperature. These features have been associated with increased infectious burden and severity of illness. However, fever alone is an insensitive indicator of sepsis; in fact, hypothermia is more predictive of illness severity and death.

Tachypnea is a common and often underappreciated feature of sepsis. It is an indicator of pulmonary dysfunction and is commonly found in pneumonia and ARDS, both of which are associated with increased mortality in sepsis.

The frequency of ARDS in sepsis has been reported to range from 18% to 38% (with gram-negative sepsis, from 18% to 25%). The severity of ARDS may range from mild lung injury to severe respiratory failure. The onset of ARDS usually is within 12-48 hours of the inciting event. The patients demonstrate severe dyspnea at rest, tachypnea, and hypoxemia; anxiety and agitation are also present.

For more on the presentation and physical examination of patients with sepsis, read here.

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