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  • • Infection

    • Either high or low cardiac output

    • Hypotension

    • Low systemic vascular resistance

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Epidemiology

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  • • ICU patients

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Symptoms and Signs

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  • • Fever and chills

    • Hypotension

    • Evidence of infection or perforation

    • Warm, flushed skin

    • Tachycardia

    • Anxiety and confusion

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Laboratory Findings

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  • • Elevated WBC count

    • Acidemia

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  • • High-output septic shock can be produced by bowel perforation, necrotic intestine, abscesses, gangrene, and soft-tissue infections

    • Cardiovascular findings of low-output sepsis are identical to those of hypovolemic shock

    • -Diagnosis usually clear from clinical circumstances

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  • • Physical exam

    • CBC

    • ABG

    • Serum lactate

    • Blood, sputum and urine cultures

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  • • Invasive monitoring (pulmonary artery catheter)

    • IV fluid resuscitation

    • Inotropes

    • Antibiotics

    • Correction of GI leaks

    • Debridement of necrotic tissue

    • Drainage of pus

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Surgery

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  • • Remove necrotic tissue or debride or drain infection

    • Indications

    • GI leaks or bowel necrosis

    • Necrotic tissue

    • Drainable pus collections

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Medications

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  • • Inotropes

    • Antibiotics

    • Vasopressors (rarely)

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Treatment Monitoring

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  • • Pulmonary artery catheter

    • Arterial line

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Complications

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  • • Multiorgan system failure

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Prognosis

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  • • Determined by underlying etiology

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References

O’Grady NP et al: Practice parameters for evaluating new fever in critically ill adult patients. Task Force of the American College of Critical Care Medicine of the Society of Critical Care Medicine in collaboration with the Infectious Disease Society of America. Crit Care Med 1998;26:392.  [PubMed: 9468180]
Wilmore DW: Metabolic response to severe surgical illness: overview. World J Surg 2000;24:705.  [PubMed: 10773123]

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