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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.
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
Etiology (cause) of Septic Shock
- *Nosocomial infection with gram negative bacilli
- *In 1/3 by gram positive cocci & candida organisms
Who does Septic Shock OCCUR in?
- Immunocompromised pts.
- Pts. with chronic disease
- Patients under 35
- Pregnant women
Risk Factors for Septic Shock
- 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
Pathogenesis of Septic Shock
- Release toxins
- Vasodilation of arteries and arterioles occurs--> Decrease systemic vascular resistnace
- Later decrease C.O. ---> higher peripheral resistance
- Blood flow impaired: O2 and CO2 transport affected
Signs & Symptoms of Septic Shock
- Altered mental: earlies sign
- Hypotension: blood pressure drop
- Warm skin
- 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
Diagnosis of Septic Shock
- Hypovolemic shock responds to volume repletion
- Cardiogenic shock associated with MIembolization
- Obstructive shock: complication of PA obstruction from
What's the C.O. of Septic Shock?
NL or increased with decreased systemic vascular resistance and warm dry skin
What's the C.O. of a LATE sign of septic shock?
Decresed C.O. with increased pulmonary vascular resistance
What Helps Diagnose Septic Shock?
Pulmonary Artery Catheter: to exclude nonseptic causes of shock
ABGs of Septic Shock
- Early: Respiratory alkalosis
- Progressive: Metabolic acidosis
- Early respiratory failure leads to hypoxemia
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
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
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
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
What Do You Give For Diuresis of Septic Shock Pts.?
Mannitol or furosemide
What do you give for Pts. in Heart Failure or in DIC with Septeci Shock?
Digitalis or Heparin