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Septic Shock

Deanna Armstrong English

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Septic Shock

Assessment
- Hemodynamic Assessments
  - Decreased Systemic vascular resistance & Central venous pressure
  - Tachycardia
  - Decreased pulse pressure
  - Hypotension
  - Decreased pulse pressure
  - Increased Pulmonary vascular resistance
  - Unstable pulmonary artery pressure
  - Unstable Cardiac Output
- Signs & Symptoms
  - Body temperature above 38.3 or below 36 degrees celsius
    - Extreme temperature fluctuations (warm and flushed at early stages, cool at late stages)
  - SOB, confusion, Light-headedness, lethargy
  - Decreased Urine Ouput
  - Respiratory rate >20 bpm, hyperventilation
  - Low BP that does not respond to fluid replacement
  - Heart rate > 90 bpm, palpitations
  - Crackles, hypoxemia
  - Agitation
- Risk Factors
  - Age (newborns, older adult >65)
  - Poor Nutrition
  - Major Surgery
  - Suppressed immune system (HIV, Chemotherapy)
  - Infection
    - Exposure to catheters, breathing tubes, IV’s
    - Viruses, Fungi, Parasites, Bacteria (gram negative - Escherichia coli and gram positive - Streptococcus pneumonia, Staphylococcus aureus)
    - Extended Hospitalization
    - Pneumonia
  - Prior Comorbidities
    - Diabetes
    - Heart Failure
    - Chronic Kidney Disease
    - Cancer
Diagnosis
- Septic Shock = the presence of sepsis with hypotension despite adequate fluid resuscitation, along with the presence of tissue perfusion abnormalities
  - Sepsis is a systemic inflammatory response to infection.
- Diagnostic Tests & Assessments
  - Patient History (i.e. infection, trauma, surgery)
  - Hemodynamic Monitoring (i.e. arterial pressure, central venous pressure, pulmonary artery pressure)
    - Systolic Arterial Pressure <90 mmHg
    - Mean Arterial Blood Pressure <65 mmHg
  - High Base Deficit
  - Elevated lactate levels (>4mmol/L)
  - 12-lead ECG & continuous cardiac monitoring
  - Positive Blood Culture
    - Blood, wound exudate, stool, urine, sputum, to determine microorganism causing infection.
  - Decreased Platelet Levels
  - Decreased Urine Sodium Levels
  - Increased Glucose Levels
  - Continuous Pulse Oximetry
Treatment
- Restore Tissue Perfusion
  - Provide Fluid Ressucitation until the following labs are met: CVP = 15 mmHg, PAOP = 10-12mmHg
  - 6-10 L of isotonic crystalloids & 2-4 L of colloids
- Supportive Therapy
  - Obtain Blood Cultures
  - Monitor Temperature
  - Control Blood Glucose Levels (between 4.44-6.11 mmol/L)
  - Prevent Stress Ulcers
- Oxygen Maintenance
  - Secure a patent airway
  - Provide Oxygen
  - Initiate Mechanical Ventilation or intubation if needed
  - Continuous Monitoring of oxygen saturation
- Drug Therapy
  - Antibiotics
    - Initially broad-spectrum antibiotics, then more specific antibiotics once microorganism has been identified
  - Corticosteroids (i.e. Hydrocortisone)
    - Increases heart rate, & Blood pressure
    - Decreases capillary permeability
  - Inotropes (i.e. Dobutamine)
    - To offset decrease in stroke volume from vasopressor drugs
  - Anticoagulants (i.e. low dose or low weight heparin, such as enoxzparin)
    - Prophylaxis of deep vein thrombosis
  - Histabine H2 Blockers (i.e. Pepcid)
    - Stress ulcer prophylaxis
  - Vasopressors (i.e. dopamine, norepinephrine, pressyn)
    - Increases Systemic vascular resistance, central venous pressure, and pulmonary artery occlusive pressure
    - increases blood pressure
    - Stabilizes Cardiac Output
    - Increases Vascular Tone
    - increases Mean Arterial Pressure
    - Increases Urine Output
Complications
- Risk of experiencing these complications depends on the following:
  - Early Recognition
  - Age (< one year or >65 years old)
  - Prompt Treatment
  - Pre-existing medical conditions
  - Cause and Origin of Infection
- Patients in Septic Shock at risk of experiencing:
  - Abnormal blood clotting
  - Heart Failure
  - Respiratory Failure
  - Loss of portion of extremities
  - Stroke
  - Liver Failure
  - Loss of proportion of Bowel
  - Kidney Failure
  - Death
By Devon Thompson & Deanna Armstrong