Stage 1: Infection enters bloodstream (bacteria, fungus, virus) 

Stage 2: Immune system realizes the body is being invaded 

Stage 3: Inflammatory systems TRIGGERED & releases: inflammatory mediators (increasing WBC's) & cytokines inside the bloodstream

Stage 4: SIRS (systemic inflammatory response syndrome) is identified: 
MUST MEET 2/4 of requirements to be SIRS: 
SIRS Requirements Include: 
- Temp> 100.4 or <96.0 
-RR > 20
- HR> 90 BPM 
- WBC> 12K or <4K 

(If 2/4 SIRS criteria met and patient has an infection, the patient is diagnosed to have SEPSIS)

Stage 5: SEPSIS: immune system release causes:

• VASODILATION: limited blood flow going into cells leading to HYPOTENSION

• Fluid in circulatory system will bleed into interstitial tissue 

• HYPOVOLEMIA

• CAPILLARY LEAK: leaks blood & fluid and swells in interstitial tissue 

• Platelet aggregation: clots will begin to form 

• Clotting factors will be at risk= RISK FOR DIC: bleeding out from body= swelling in interstitial tissue

• Then leads to decreased myocardfunction

• If many cytokines are also present will affect myocardial function: can decrease ejection contraction
  
  Stage 6: SEPTIC SHOCK: includes sepsis criteria, and now ORGAN DYSFUNCTION
  
  SEPTIC SHOCK: multi- organ dysfunction syndrome
  WORSENING MORTALITY!!

• Signs & Symptoms: 
  ***“EARLY:” WARM

• - warm/flushed skin
  - Hyperdynamic: vasodilation 
  - Decrease BP, Increase HR 
  - INC RR, Temp, INC. CO2, restless anxiety 
  ***“LATE:”COLD = uncompensated 

• hypodynamic = vasoconstriction 

• cold , clammy skin

• Severe hypotension, INC HR, RR, oliguria, coma, hypothermia 

• ORGAN DYSFUNCTION 

• MAP<65, AMS, LACTATE >2, UOP <0.5, ARDS

• COMA!!

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**When a patient has septic shock they are METABOLIC ACIDOSIS- pH becomes too low & can't get rid of CO2, lactic acid, or waste; kidneys can no longer balance pH and PERFUSE!!