Septic Shock

• • Infection

  • Either high or low cardiac output

  • Hypotension

  • Low systemic vascular resistance

Epidemiology

• • ICU patients

Symptoms and Signs

• • Fever and chills

  • Hypotension

  • Evidence of infection or perforation

  • Warm, flushed skin

  • Tachycardia

  • Anxiety and confusion

Laboratory Findings

• • Elevated WBC count

  • Acidemia

• • 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

• • Physical exam

  • CBC

  • ABG

  • Serum lactate

  • Blood, sputum and urine cultures

• • Invasive monitoring (pulmonary artery catheter)

  • IV fluid resuscitation

  • Inotropes

  • Antibiotics

  • Correction of GI leaks

  • Debridement of necrotic tissue

  • Drainage of pus

Surgery

• • Remove necrotic tissue or debride or drain infection

  • Indications

  • GI leaks or bowel necrosis

  • Necrotic tissue

  • Drainable pus collections

Medications

• • Inotropes

  • Antibiotics

  • Vasopressors (rarely)

Treatment Monitoring

• • Pulmonary artery catheter

  • Arterial line

Complications

• • Multiorgan system failure

Prognosis

• • Determined by underlying etiology

References