History: The individual usually will complain of fever and chills. The individual may complain of shortness of breath (dyspnea), rapid heart rate (tachycardia), and a feeling of apprehension or confusion. There may be specific symptoms suggesting the original site of infection (e.g., abdominal pain if gangrene of the intestine is present), but such localized symptoms often are absent. There may be a history of recent surgery, lung infections (e.g., pneumonia) or other severe known infections, recent acute trauma, puncture wounds, deep cuts, or burns. The individual may report having an invasive device (e.g., indwelling catheter). The individual may have a history of receiving immunosuppressive therapy, chemotherapy, antibiotic therapy, or corticosteroids, and/or may have a history of an underlying chronic illness such as diabetes or chronic obstructive pulmonary disease (COPD), or other debilitating disease such as AIDS, cirrhosis, or cancer. Physical exam: On physical exam, the individual usually will have a fever; although some individuals may be have a subnormal temperature (hypothermic). Examination, symptoms, and history may suggest the source of the infection; possible sources can be gastrointestinal, genitourinary, respiratory, intravascular, or cardiovascular. If the individual has an invasive device, the entry site may show signs of infection; however only 50% of patients with infection within an IV line also have an infected insertion site (Cunha). Other common signs of sepsis may include rapid, shallow breathing; flushed skin and sweating; weak pulse; dehydration and decreased urine output; sudden high fever with chills; cold hands and feet with a bluish tinge to the skin (cyanosis); tachycardia (> 90 beats per minute); extreme exhaustion (prostration); and changes in mental status (e.g., confusion, agitation, disorientation, coma), especially among the elderly. Some individuals develop a red, pinpoint rash (petechiae) caused by capillary hemorrhages beneath the skin. A rectal examination in men may reveal tenderness suggesting prostatic abscess or signs of prostatic hypertrophy. Signs of organ failure may include a drop in blood pressure or an arrhythmia in cardiovascular failure; reduced respiratory rate and low blood oxygen levels (hypoxemia) in respiratory failure; and decreased urinary output in kidney failure. In patients with known or suspected infection, sepsis is a likely diagnosis if systemic signs of inflammation are present. However, confirmatory diagnostic testing is essential. Tests: Normally tests begin with a complete blood count (CBC). A white blood cell (WBC) count and peripheral smear may show nonspecific signs of infection. The platelet count may decrease markedly early in sepsis. Blood chemistries are done to monitor electrolytes as an indication of fluid balance and renal functioning. Cardiac enzymes will help evaluate heart function, and lactate levels may be increased as shock develops. Erythrocyte sedimentation rate (ESR), procalcitonin, and C-reactive protein are measured to identify possible inflammatory processes. Coagulation tests may be done. Liver and kidney function tests also may be performed. Adrenal function may be evaluated by measuring serum cortisol levels. A blood gas analysis may show hypoxemia. Blood samples or samples of sputum (mucus) or spinal fluid may be cultured to identify the infective organism. Urinalysis and urine culture will be done, especially in individuals who have had indwelling urinary catheters in place. An electrocardiogram (ECG) may show abnormalities in heart rhythm. A chest x-ray may be done to look for evidence of pneumonia or pancreatitis. Ultrasound imaging may help detect abdominal abscesses or rule out biliary tract obstruction, and a computed tomography (CT) scan may be done if non-biliary infection in the abdomen is suspected or to investigate kidney pathology. Monitoring is an ongoing process as sepsis is treated, and these tests will be repeated as the individual's condition changes. |