Management of

Septic Shock

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www....
Septic Shock
• Septic shock- once a uniformly fatal
condition with 100% mortality.
• Present recovery rates are upto 50%.
...
Septic Shock
I.

Introduction.

II.

Pathophysiology

III.

Clinical Manifestations

IV. Management
www.indiandentalacadem...
Introduction.
• What is shock?
Shock is a state of acute disruption of
circulatory function, resulting in
insufficiency of...
Septic Shock
I.

Introduction.

II.

Pathophysiology

III.

Clinical Manifestations

IV. Management
www.indiandentalacadem...
Pathophysiology
• The nidus of infection:
– Localised infections ( otitis, pneumonia,
meningitis etc.,)
– Colonization of ...
Pathophysiology
The Pathogen:
• Neonates: GBHS, enterobacteriacae, listeria,
Staph aureus, HSV.

• Infants: Hib, Strep pne...
Pathophysiology
• The agent - host interaction leads to

‘CHAOS’

www.indiandentalacademy.com
Pathophysiology
• What ‘type of shock’ is septic shock?
Septic shock has features of :
– Hypovolemic shock
– Cardiac shock...
Septic Shock
I.

Introduction.

II.

Pathophysiology

III.

Clinical Manifestations

IV. Management
www.indiandentalacadem...
Clinical Manifestations.
The Continuum of infection
to
MODS and Death
(Clinical Definitions)

www.indiandentalacademy.com
Clinical Manifestations.
Recognition of Septic Shock:
• Inflammatory triad– Fever
– Tachycardia
– flushed skin

Warm
Shock...
Clinical Manifestations.
• Hypotension
–
–
–
–
–
–
–

Cold and clammy skin
Mottling
Tachycardia
Cyanosis
Narrow pulse pres...
Clinical Manifestations.
Staging of Septic Shock:
I. Compensated / Preshock / Hyperdynamic
II.Decompensated / Organ hypope...
Septic Shock
I.

Introduction.

II.

Pathophysiology

III.

Clinical Manifestations

IV. Management
www.indiandentalacadem...
Management
Prevention:
1. Immunisation
2.

Prompt treatment of local infections

3.

Hospitalized patient: look out for ni...
Management
Recognise septic shock early:
• Remember- Inflammatory triad
Signs of hypoperfusion
• Do not wait for the BP to...
Management.
• Two means of death:
1. Shock.
2. Multi organ failure.
• Aims of treatment:
1. Assure perfusion of critical v...
Management

STEPS
1. Prevent / correct hypoxemia: Supplement
oxygen 95-100%.
2. IV access: peripheral vein.
3. If IV acces...
Management

STEPS
Improved perfusion =>
a. CFT
b. Warmth
c. Strong pulses
d. mental status
e. Tachycardia
f. BP (ideal = 9...
Management

STEPS
5. Establish a 2nd IV line for Dopamine
infusion (Draw blood for culture)
6. Administer IV antibiotics
<...
Management

STEPS
7. Correct metabolic derangement:
– Metabolic acidosis.
– Hyper or hypoglycemia : always correct
hypogly...
Management

STEPS
8. DIC:
• Restoration of normovolemia reverses
abnormal activation.
• ‘Component replacement’
(Goal - No...
Management

STEPS
9. Recognize and manage organ failure:
a. Cardiovascular support:
Rate & rythm- correct 02, acidosis, Ca...
Management

STEPS
9. Recognize and manage organ failure:
b. Renal: Volume replacement
Low dose dopamine
?diuretic with vol...
Management

STEPS
9. Recognize and manage organ failure:
c. Respiratory support:
Supplement 02,
Early intubation and PPV (...
Monitoring a Child With Septic
Shock.
• Frequent monitoring is
MOST IMPORTANT to recognise and Rx
complications.
1. Pulse
...
Management- summary.
Five important points
1. ABC, supplement 02 always.
2. IV or IO access and fluid resuscitation upto
6...
References
1.Nelson TB of Pediatrics. 16th edn.
2.Medical Emergencies in ChildrenMeharban singh
3.PALS: 1997, AAP & AHA.
4...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Septic shock /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  1. 1. Management of Septic Shock INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Septic Shock • Septic shock- once a uniformly fatal condition with 100% mortality. • Present recovery rates are upto 50%. • Significance: Frequent occurrence and high mortality. www.indiandentalacademy.com
  3. 3. Septic Shock I. Introduction. II. Pathophysiology III. Clinical Manifestations IV. Management www.indiandentalacademy.com
  4. 4. Introduction. • What is shock? Shock is a state of acute disruption of circulatory function, resulting in insufficiency of tissue perfusion,oxygen utilization and cellular energy producion. Low BP is NOT sine qua non of shock. www.indiandentalacademy.com
  5. 5. Septic Shock I. Introduction. II. Pathophysiology III. Clinical Manifestations IV. Management www.indiandentalacademy.com
  6. 6. Pathophysiology • The nidus of infection: – Localised infections ( otitis, pneumonia, meningitis etc.,) – Colonization of mucosal and invasion ( Hib, menigococci) – Occult bacteremia ( 3mo to 3 years ) – Nosocomial : ‘at risk patients’ www.indiandentalacademy.com
  7. 7. Pathophysiology The Pathogen: • Neonates: GBHS, enterobacteriacae, listeria, Staph aureus, HSV. • Infants: Hib, Strep pneumoniae, Staph aureus. • Children:Strep pneumoniae, N.meningitidis, S.aureus, enterobacteriacae, Hib. • Immunocompromised: Enterobacteriacae,Staph, Pseudomonas, Candida. www.indiandentalacademy.com ‘Pathophysiology’
  8. 8. Pathophysiology • The agent - host interaction leads to ‘CHAOS’ www.indiandentalacademy.com
  9. 9. Pathophysiology • What ‘type of shock’ is septic shock? Septic shock has features of : – Hypovolemic shock – Cardiac shock – Distributive shock. www.indiandentalacademy.com
  10. 10. Septic Shock I. Introduction. II. Pathophysiology III. Clinical Manifestations IV. Management www.indiandentalacademy.com
  11. 11. Clinical Manifestations. The Continuum of infection to MODS and Death (Clinical Definitions) www.indiandentalacademy.com
  12. 12. Clinical Manifestations. Recognition of Septic Shock: • Inflammatory triad– Fever – Tachycardia – flushed skin Warm Shock • Hypoperfusion – – – – Altered sensorium Urine output >CFT www.indiandentalacademy.com Wide pulse pressure.......bounding pulses
  13. 13. Clinical Manifestations. • Hypotension – – – – – – – Cold and clammy skin Mottling Tachycardia Cyanosis Narrow pulse pressure Hypoxemia Acidosis. www.indiandentalacademy.com Cold shock
  14. 14. Clinical Manifestations. Staging of Septic Shock: I. Compensated / Preshock / Hyperdynamic II.Decompensated / Organ hypoperfusion III. End organ failure / Irreversible www.indiandentalacademy.com
  15. 15. Septic Shock I. Introduction. II. Pathophysiology III. Clinical Manifestations IV. Management www.indiandentalacademy.com
  16. 16. Management Prevention: 1. Immunisation 2. Prompt treatment of local infections 3. Hospitalized patient: look out for nidus of infection- IV lines, catheters, E.tubes www.indiandentalacademy.com
  17. 17. Management Recognise septic shock early: • Remember- Inflammatory triad Signs of hypoperfusion • Do not wait for the BP to fall ! • Lower limit for systolic BP = 70 +( age x 2) www.indiandentalacademy.com
  18. 18. Management. • Two means of death: 1. Shock. 2. Multi organ failure. • Aims of treatment: 1. Assure perfusion of critical vascular beds. ( cerebral, coronary, renal) 2. Rx underlying cause. www.indiandentalacademy.com
  19. 19. Management STEPS 1. Prevent / correct hypoxemia: Supplement oxygen 95-100%. 2. IV access: peripheral vein. 3. If IV access fails: Intraosseous line. 4. Fluid resuscitation: 20mL/Kg NS or RL as bolus, repeat upto 60 mL/Kg. End point : Improved perfusion. www.indiandentalacademy.com
  20. 20. Management STEPS Improved perfusion => a. CFT b. Warmth c. Strong pulses d. mental status e. Tachycardia f. BP (ideal = 90 + age x 2; Min = 70+ age x 2) g. Urine output. www.indiandentalacademy.com
  21. 21. Management STEPS 5. Establish a 2nd IV line for Dopamine infusion (Draw blood for culture) 6. Administer IV antibiotics <2 mo:Ampicillin + gentamicin or Ampicillin+ceftriaxone/cefataxime >2mo: Ceftriaxone or Cefotaxime alone or www.indiandentalacademy.com Ampicillin + Chloramphenicol
  22. 22. Management STEPS 7. Correct metabolic derangement: – Metabolic acidosis. – Hyper or hypoglycemia : always correct hypoglycemia. www.indiandentalacademy.com
  23. 23. Management STEPS 8. DIC: • Restoration of normovolemia reverses abnormal activation. • ‘Component replacement’ (Goal - Normal PT, PTT, fibrinogen, PC = 40,000 to 1 Lakh/cumm.) a. FFP - most beneficial in early stages. b. Cryo- consider 1 unit/3 units of FFP transfused. www.indiandentalacademy.com c. Platelet concentrate
  24. 24. Management STEPS 9. Recognize and manage organ failure: a. Cardiovascular support: Rate & rythm- correct 02, acidosis, Ca, Mg, K variations Stroke volume - fluid correction & replace losses Ionotrope support. www.indiandentalacademy.com
  25. 25. Management STEPS 9. Recognize and manage organ failure: b. Renal: Volume replacement Low dose dopamine ?diuretic with vol expansion Indications for dialysis: Hyperkalemia refractory metabolic acidosis Anuria despite diuresis www.indiandentalacademy.com BUN>100mg%
  26. 26. Management STEPS 9. Recognize and manage organ failure: c. Respiratory support: Supplement 02, Early intubation and PPV ( PEEP) d. GI: Antacids, sucralfate, early enteral nutrition. www.indiandentalacademy.com
  27. 27. Monitoring a Child With Septic Shock. • Frequent monitoring is MOST IMPORTANT to recognise and Rx complications. 1. Pulse 5. Urine output. 2. BP 6. ABG 3. Level of consciousness 7. PT/PTT/PC 4. 02 saturation www.indiandentalacademy.com 8. CVP
  28. 28. Management- summary. Five important points 1. ABC, supplement 02 always. 2. IV or IO access and fluid resuscitation upto 60 mL/Kg. 3. Early dopamine infusion @10µg/Kg/min 4. Empirical antibiotic. 5. Frequent monitoring. www.indiandentalacademy.com
  29. 29. References 1.Nelson TB of Pediatrics. 16th edn. 2.Medical Emergencies in ChildrenMeharban singh 3.PALS: 1997, AAP & AHA. 4.PCNA: Intensive Care. 1987. 5.TB of Pediatric Critical Care- P.R.Holbrook 6.Handbook of PIC- Rogers & Hefaler 7.Various Speakers: Critical Care CME, May www.indiandentalacademy.com 2002
  30. 30. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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