Initial Emergency Department Diagnosis and Management of Adult Patients with Severe Sepsis and Septic Shock

Table 2 Common Causes of Severe Sepsis by Organ System*

Organ	Etiology	Diagnostic Study
Lungs	Pneumonia	Chest radiograph
	-Hospital acquired	CT scan of the chest
	-Community acquired
Abdomen	Appendicitis	Abdominal radiograph
	Cholecystitis/Cholangitis	CT scan of the abdomen and pelvis
	Bowel perforation	Right upper quadrant abdominal ultrasound
	Peritonitis	HIDA scan
Urinary Tract	Cystitis	Urine analysis and culture
	Pyelonephritis	Renal ultrasound
	Urosepsis	*Remove any instrumentation ie. Indwelling foley catheter
Skin	Cellulitis	Isolation and culture
	Wound
Bones	Osteomyelitis	Bone scan or MRI
	Sinusitis	CT scan of the maxillofacial bones and sinuses
Central Nervous System	Meningitis/Encephalitis	Lumbar puncture
	Spinal abscess	MRI of the brain and/or spine
		CT scan of the brain
Blood	Secondary from other source	Blood culture
	Catheter associated	*Remove any instruments that may seed infection ie. central line, pacemaker wires
Unknown	*Approximately 20% of patients will have an unknown source.

*Adapted from Levy et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit. Care Med. 2010;38(2):367–374.

ISSN: 1757-7241