Systemic Inflammatory Response Syndrome (SIRS): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination-including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin, mucous membranes, and sclerae (white part of the eye) [cyanosis (bluish discoloration of the skin/mucous membranes in the absence of oxygen)?; generalized edema (water retention in the tissues)?; petechiae (“flea-like bleeding”) in coagulation disorders?]
        • Determination of capillary refill time (CRT) to assess microcirculation and circulatory situation; CRT = time required for capillary bed to refill after external application of pressure (3-5 sec); measurement on finger or sternum under optimal light conditions; normal CRT:
          • In neonates: – 3 sec.
          • For children 2-3 sec.
          • Notice: In the guideline on sepsis in children, a RKZ > 2 sec on the body trunk is given as a criterion for SIRS with organ complication
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Auscultation (listening) of the heart.
    • Auscultation of the lungs
    • Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
  • Assessment of consciousness using the Glasgow Coma Scale (GCS).
  • Assessment of organ function using the SOFA score (for: “Sequential (Sepsis-Related) Organ Failure Assessment Score”) [see below Sepsis/Classification].

Square brackets [ ] indicate possible pathological (pathological) physical findings.Glasgow Coma Scale (GCS) – scale for estimating a disorder of consciousness.

Criterion Score
Eye opening spontaneous 4
on request 3
on pain stimulus 2
no reaction 1
Verbal communication conversational, oriented 5
conversational, disoriented (confused) 4
incoherent words 3
unintelligible sounds 2
no verbal reaction 1
Motor response Follows prompts 6
Targeted pain defense 5
untargeted pain defense 4
on pain stimulus flexion synergisms 3
on pain stimulus stretching synergisms 2
No response to pain stimulus 1

Assessment

  • Points are awarded for each category separately and then added together. The maximum score is 15, the minimum 3 points.
  • If the score is 8 or less, a very severe brain dysfunction is assumed and the there is a risk of life-threatening respiratory disorders.
  • With a GCS ≤ 8, securing the airway by endotracheal intubation (insertion of a tube (hollow probe) through the mouth or nose between the vocal folds of the larynx into the trachea) must be considered.