Long Brit, Gottlieb Michael
Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
Am J Emerg Med. 2025 Apr;90:169-178. doi: 10.1016/j.ajem.2025.01.055. Epub 2025 Jan 22.
Sepsis and septic shock are common conditions evaluated and managed in the emergency department (ED), and these conditions are associated with significant morbidity and mortality. There have been several recent updates in the literature, including guidelines, on the evaluation and diagnosis of sepsis and septic shock.
This is the first paper in a two-part series that provides emergency clinicians with evidence-based updates concerning sepsis and septic shock. This first paper focuses on evaluation and diagnosis of sepsis and septic shock.
The evaluation, diagnosis, and management of sepsis have evolved since the first definition in 1991. Current guidelines emphasize rapid diagnosis to improve patient outcomes. However, scoring systems have conflicting data for diagnosis, and sepsis should be considered in any patient with infection and abnormal vital signs, evidence of systemic inflammation (e.g., elevated white blood cell count or C-reactive protein), or evidence of end-organ dysfunction. The clinician should consider septic shock in any patient with infection and hypotension despite volume resuscitation or who require vasopressors to maintain a mean arterial pressure ≥ 65 mmHg. There are a variety of sources of sepsis but the most common include pulmonary, urinary tract, abdomen, and skin/soft tissue. Examples of other less common etiologies include the central nervous system (e.g., meningitis, encephalitis), spine (e.g., spinal epidural abscess, osteomyelitis), cardiac (e.g., endocarditis), and joints (e.g., septic arthritis). Evaluation may include biomarkers such as procalcitonin, C-reactive protein, and lactate, but these should not be used in isolation to exclude sepsis. Imaging is a key component of evaluation and should be based on the suspected source.
There have been several recent updates in the literature including guidelines concerning sepsis and septic shock; an understanding of these updates can assist emergency clinicians and improve the care of these patients.
脓毒症和脓毒性休克是急诊科评估和处理的常见病症，这些病症与显著的发病率和死亡率相关。近期文献中有多项关于脓毒症和脓毒性休克评估与诊断的更新内容，包括指南。
这是一个两部分系列论文中的第一篇，为急诊临床医生提供关于脓毒症和脓毒性休克的循证更新。第一篇论文聚焦于脓毒症和脓毒性休克的评估与诊断。
自1991年首次定义以来，脓毒症的评估、诊断和管理已经有所发展。当前指南强调快速诊断以改善患者预后。然而，评分系统在诊断方面的数据存在冲突，对于任何有感染且生命体征异常、存在全身炎症证据（如白细胞计数升高或C反应蛋白升高）或存在器官功能障碍证据的患者，都应考虑脓毒症。对于任何有感染且尽管进行了液体复苏仍存在低血压或需要血管活性药物来维持平均动脉压≥65 mmHg的患者，临床医生应考虑脓毒性休克。脓毒症有多种来源，但最常见的包括肺部、泌尿道、腹部和皮肤/软组织。其他不太常见病因的例子包括中枢神经系统（如脑膜炎、脑炎）、脊柱（如脊柱硬膜外脓肿、骨髓炎）、心脏（如心内膜炎）和关节（如脓毒性关节炎）。评估可能包括生物标志物，如降钙素原、C反应蛋白和乳酸，但不应单独使用这些指标来排除脓毒症。影像学检查是评估的关键组成部分，应基于可疑来源进行。
近期文献中有多项关于脓毒症和脓毒性休克的更新内容，包括指南；了解这些更新内容有助于急诊临床医生并改善对这些患者的治疗。
