septic shock

• pathophysiology

  • life threatening organ dysfunction caused by infection
  • #1 cause of distributive shock
  • invasion of microorganisms
  • progressive inflammation caused by host organism
  • invasion leads to inflammation leads to coag system activated leading to dilated blood vessels making a localized red, warm, edema.
  • once no longer localized and becomes systemic and immune response is uncontrolled sepsis occurs and causes excessive release of pro inflammatory cells leading to systemic inflammation, massive vasodilation, and enhanced coagulation
• causes

  • immunosuppression
  • significant bacteremia
  • gram positive organisms like staph or strep
  • sometimes gram negative like e coli
  • could be fungal infection
• clinical manifestations

  • metabolic acidosis
  • hypoxemia
  • coagulation disorders (DIC)
  • hypotension
  • decreased skin perfusion/mottling
  • poor vascular tone
  • vasodilation
  • blood pooling in venous system
  • decreased venous return but have adequate blood volume
• early stages

  • warm sepsis
  • tachycardia
  • bounding pulses
  • warm, flushed skin
  • febrile
  • normal BP (slightly elevated)
  • confusion
  • decreased organ perfusion
  • possible decreased urine output
  • increased CO
• Late stages

  • Cold shock
  • cool, pale skin
  • weak pulses
  • hypothermia
  • taachycardia
  • hypotension
  • end organ hypoperfusion
  • coma
  • decreased CO
• Complications

  DIC

  MODS
• Management

  • ID infection
  • labs
  • SOFA
  • aseptic technique
  • Sepsis bundle
  • intubation
  • ecmo
  • dialysis
• Sepsis bundle

  • done within the first hour of identifyfing sepsis
  • lactate level, 2 sets of blood cultures, CBC, coag, CMP, ABG, liver
  • broad spectrum abx within 1 hour of arrival
  • fluids
  • vasopressors (if fluids cannot keep map above 65)
• Meds

  • low dose steroids if unresponsive to fluids or pressors
  • steroids cause increased glucose and immunocompromised
• MODS

  • Excessive inflammation
  • decreased oxygen delivery to organs = decreased tissue perfusion
  • cell death, vasodilation, clotting
  • hyperglycemia
  • metabolic acidosis
  • Organ failure
  • first symptomatic organ is Lungs (ards)
  • then renal, liver, GI
  • 100% mortality is cardiac and neurological involved