What should be considered during the physical exam of systemic inflammatory response syndrome (SIRS)?

Updated: May 07, 2018
  • Author: Lewis J Kaplan, MD, FACS, FCCM, FCCP; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Key points associated with physical examination are as follows:

  • Patients at the extremes of age (both young and old) may not manifest typical criteria for SIRS; therefore, clinical suspicion may be required to diagnosis a serious illness (either infectious or noninfectious)

  • Patients receiving a beta-blocker or a calcium channel blocker are often unable to elevate their heart rate and, therefore, tachycardia may not be present

  • Although low blood pressure is not a criterion for SIRS, it is still an important marker; if the blood pressure is low, the establishment of intravenous access and fluid resuscitation is of utmost importance; frank hypotension associated with SIRS is uncommon unless the patient is septic or severely dehydrated (hypotension may lead to the patient being admitted or transferred to a higher acuity unit)

  • Respiratory rate is the most sensitive marker of the severity of illness

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