spectrum comparison
Sepsis Progression: SIRS → Sepsis → Severe Sepsis → Septic Shock — The Escalation Timeline
Calling everything "sepsis" costs time and lives. Each stage along this spectrum triggers specific, escalating interventions — and the NCLEX will test whether you know which stage demands fluids alone versus vasopressors. Misclassifying the stage means choosing the wrong priority action.
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Progression3 stages
Progression — 3 stages
SIRS (Screen)
What's happening- Systemic inflammation, any cause
- Non-infectious causes too (burns)
Key findings- ★≥2: T >38/<36, HR >90, RR >20, abnl WBC
- No organ dysfunction yet
- BP usually normal
Nursing focus- Screen with SIRS or NEWS
- Look for an infection source
- Reassess often for organ dysfunction
Lactate trend- Usually < 2 mmol/L
Sepsis
What's happening- ★Infection + new organ dysfunction
- Severe sepsis = retired term (Sepsis-3)
Key findings- New AMS, ↓ urine output
- ↓ platelets, ↑ bilirubin
- BP responds to fluids
Nursing focus- Cultures BEFORE antibiotics
- Antibiotics within 1 hr
- 30 mL/kg crystalloid for hypoperfusion
Lactate trend- ≥ 2 mmol/L = hypoperfusion
- Recheck if initial > 2
Septic Shock
What's happening- Vasopressor-dependent hypotension
- Highest mortality (> 40%)
Key findings- ★Vasopressors needed for MAP ≥ 65
- Lactate > 2 despite fluids
- Multi-organ failure
- New AMS, ↓ urine output
Nursing focus- Norepinephrine first-line, MAP ≥ 65
- Hydrocortisone if refractory
- Antibiotics within 1 hr
- 30 mL/kg crystalloid for hypoperfusion
- Cultures BEFORE antibiotics
Lactate trend- > 2 despite adequate fluids
- Often > 4 (tissue hypoxia)
- Recheck if initial > 2
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Clinical Pearl
Still hypotensive after 30 mL/kg fluids? That's septic shock — start vasopressors, not more fluid.
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