SEPTIC SHOCK

SEPTIC SHOCK

1. TREATMENT

   • Inital
     • Oxygen
     • Fluids
       • NS 0.9%
       • Blood
         • If HgB <120g/L
       • Colliods
     • Blood Labs & Cultures
       • Antibiotics
         • Broad-spectrum Penicillins
         • 3rd & 4th gen. Cephalosporins
         • Aminoglycosides
     • Vasopressors
       • Dopamine
     • Inotropes
       • Dobutamine
     • Anticoagulants
       • Low Molecular Weight Heparin
     • Patent Airway
       • Prep for intubation
   • Maintenance
     • Monitor VS & Blood Glucose
       • Continuous Insulin-Glucose Drip
     • Prevent Stress Ulcers
       • Relaxation Techniques
       • Antacids - PPIs
     • Dialysis
     • Increased protein and calories

2. ASSESSMENT

   • @ Risk
     • Newborns
     • Older Adults >60y
     • Pregnant Women
     • Diabetic pts
     • Liver Failure pts
     • HIV/AIDS
     • Chemo pts
     • Kidney Failure
   • Signs & Symptoms
     • Vasodilation
     • Hypotension
     • Decreased Urine Output
     • Altered LOC
     • Tachycardia
     • Fever
     • Edema
   • Sequential Organ Failure Assessment
     • Respiratory
       • ARDS, hypoxemia, pulmonary hypertension
     • Renal
       • Decreased urine output
     • Hepatic
       • Increased ALT/AST, jaundice, decreased albumin/transferrin
     • GI
       • Decreased peristalsis, ulceration, GI bleed
     • CNS
       • Seizure, confusion, decreased LOC
     • Cardiovascular
       • Myocardial depression, decreased stroke volume, increased heart rate
     • Hematological
       • Increased PTT, INR, fibrinolysis; decreased platelet count
     • Endocrinological
       • Hyper or hypoglycemia

3. DIAGNOSIS

   • Labs
     • CBC
       • WBCs (5-10 x10^9/L)
       • Platelets (150-400 x10^9/L)
       • Hgb 140-180mmol/L (men); 120-160mmol/L (women)
     • INR/PTT
       • PTT 28-35sec
       • INR (0.81-1.2)
     • Glucose (4-8mmol/L)
     • Urinalysis & Urine Culture
       • Creatinine 53-106mcmol/L (men); 44-97mcmol/L (women)
       • BUN (3.6-7.1mmol/L)
     • Electrolytes
       • Dehydration
       • Na+ (135-145mmol/L)
       • K+ (3.5-5.0mmol/L)
     • ABGs
       • pH 7.35-7.45
       • CO2 35-45mmHg
       • HCO3- 22-26mmol/L
     • Culture & Sensitivity
     • Fibrinolysis & Cytokine Release
     • Lactic Acid (0.6-2.2mmol/L)
   • ECG, CXR, CT

4. COMPLICATIONS

   • Systemic Inflammatory Response Syndrome (SIRS)
     • Mass inflammation due to infection
     • 2+ of following:
       • Fever
         • Edema
           • Hypotension
             • Tachycardia
               • Impaired oxygenation
                 • Elevated WBC count
   • Multiple Organ Dysfunctional Syndrome (MODS)
     • 2+ organ failure related to decreased blood flow

5. By: Alexus Barning & Micah Mendoza

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