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Definition of Septic Shock
When bacteremia causes changes in circulation so tissue perfusion is critically reduced. Usually caused by gram negative organisms, staphylococci, or meningococci.
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What is Septic Shock Characterized By?
- Acute circulatory failurefollowed by hypotension & multi-organ failure
- skin warm
- urine reduced
- pt confused & less alert
- lung, kidneys, & liver failure
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Etiology (cause) of Septic Shock
- *Nosocomial infection with gram negative bacilli
- *In 1/3 by gram positive cocci & candida organisms
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Who does Septic Shock OCCUR in?
- Immunocompromised pts.
- Pts. with chronic disease
- Newborns
- Patients under 35
- Pregnant women
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Risk Factors for Septic Shock
- Diabetes
- Cirrhosis: lead to liver cancer, hits kidneys & liver
- Leukocytopenia: decreased white blood cells-can't fight
- Infection in urinary, biliary or GI tracts
- Invasive devices: catheters & drains
- Ventilators
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Pathogenesis of Septic Shock
- Release toxins
- Vasodilation of arteries and arterioles occurs--> Decrease systemic vascular resistnace
- Later decrease C.O. ---> higher peripheral resistance
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Signs & Symptoms of Septic Shock
- Altered mental: earlies sign
- Hypotension: blood pressure drop
- Warm skin
- Tachycardia
- Tachypnea
- Oligurea: urine production output drops off
- Cool, pale extremities with peripheral cyanosis and mottling: blue arms & legs
- Multi-organ fail: kidneys, lungs, liver & heart- late sign
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Diagnosis of Septic Shock
- Hypovolemic shock responds to volume repletion
- Cardiogenic shock associated with MI
embolization
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What's the C.O. of Septic Shock?
NL or increased with decreased systemic vascular resistance and warm dry skin
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What's the C.O. of a LATE sign of septic shock?
Decresed C.O. with increased pulmonary vascular resistance
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What Helps Diagnose Septic Shock?
Pulmonary Artery Catheter: to exclude nonseptic causes of shock
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ABGs of Septic Shock
- Early: Respiratory alkalosis
- Progressive: Metabolic acidosis
- Early respiratory failure leads to hypoxemia
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Mortality with septic shock is:
- 25-90% If adequate treatment not started, higher mortality.
- Once severe lactic acidosis occurs with multi-organ fail: septic shock irreversible
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Treatment with Septic Shock
- In ICU: monitor BP, arterial & venous pH, ABGs, blood lactate levels, renal function, and electrolytes
- Support with ventilation with nasal O2, intubatation or tracheostomy, and ventilator as needed.
- Antibiotics after culture & early
- DON'T GIVE VASOPRESSORS: high risk for vasoconstriction
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What Should be Measured with Septic Shock?
- Measure: central venous pressure or pulmonary artery pressure.
- Give fluid replacement until CVP reaches 10-12 cm H2O or till the PCWP reaches 12-15 mm Hg
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The Septic Shock Patient is Still Hypotensive After Volume Has Raised the PCWP to 15-18?
Give dopamine to increase BP to less than or equal to 60
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What Do You Give For Diuresis of Septic Shock Pts.?
Mannitol or furosemide
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What do you give for Pts. in Heart Failure or in DIC with Septeci Shock?
Digitalis or Heparin
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