This presentation discusses about the etiology, clinical features, complications and management of Septic Shock. The information compiled in this presentation (from medical textbooks and internet sources) does not belong to me, but has been done so for educational purposes

1. Septic
By Benisha Julian, Final Year
MBBS
Guided by : Dr. Anitha Harry
Shock

2. Infections
Bacteremia
Sepsis
(Fever, leucocytosis,
tachycadia etc.)
Severe
Sepsis
(SIRS + organ
dysfunction)
Septic
shock

3. Sepsis-induced hypotension that may
persist despite adequate fluid
resuscitation.
Septic Shock
•Systemic hypotension (BP <90mmHg)
•Severe organ dysfunction
•Maldistribution of blood flow

4. • Catheters and indwelling devices
• Major surgeries
•Extremes of Age
(< 10 years, >70years)
•Immunocompromised
conditions:
•Diabetes mellitus, malignancy, chronic
kidney disease etc
Etiology: Risk Factors
•Immunosuppresive drugs

5. Etiology: Causative organisms
Infection Common
organisms
Common causes
Respiratory tract
infection
E. coli, S. pneumoniae,
K. pneumonia, etc.
Pneumonia
Abdominal and GI
infections:
E. coli, Enterococcous,
Salmonella, etc.
Peritonitis,
strangulation hernia
Urogenital tract
infections
E. coli, Proteus, N.
gonorrhoea
CNS infections N. meningitidis
Due to foreign
bodies
S. aureus, S. epidermis,
Candida
Catheters
Indwelling devices

6. Shock and Multi organ failure
Tissue Injury
Inflammatory Response
Microbial Toxins
Adequate
Infection is
controlled.
Pathophysiology
Inadequate
Uncontrolled
Infection
Excessive

7. Inflammatory mediators
activated
Coagulation
activated
Anticoagulation
activated
Systemic Effect of
inflammation:
Fever, leucocytosis etc.
Endothelial
injury
Immunosuppression
DIC
Systemic Hypotension
Microbial
toxins
Vasodilation &
Vascular
permeability

8. Lack of
O2
Systemic
Hypotension
Vascular Permeability
& Vasodilation
Cell Necrosis
Lactate levels
Anaerobic metabolism
Hypoxia
Blood supply to tissues
Disseminated Intravascular
Coagulation (DIC)
Glucose
PyruvateLactate
Glycolysis

9. Septic Shock
Reversible Irreversible
Stages of

10. Septic Shock
Hyperdynamic Hypodynamic
Stages of
Due to hypovolaemia

11. Chills & Rigor
Fever
Hyperdynamic (or) Warm shock
(or) Compensated Stage
Warm & flushed skin
Hyperventilation
Pulse : Rapid & pounding

12. Cold & clammy skin
Mental confusion
Hyperdynamic (or) Warm shock
(or) Compensated Stage
Oliguria
Jaundice
Pulse : Feeble
Hypodynamic (or) Cold shock
(or) Decompensated Stage

13. Complications
Septic Shock
Acute respiratory
distress
syndrome
Acute kidney
Injury
Disseminated
intravascular
coagulation
Liver failure
MODS/
Death

14. Objectives of Treatment
Eliminate septic focus
Control Inflammation
Fluid resuscitation
Oxygen support

15. Vasopressors
Norepinephrine Dopamine
IV Crystalloids
30mL/kg for 4-6 hours
•Mean arterial pressure
< 65mmHg
•Lactate > 4mmol/L
•Central venous
pressure < 8mmHg
2
Volume Replacement

16. Antibiotic Therapy
• IV Broad spectrum antibiotics
3rd generation cephalosporin or
aminoglycosides
Ceftriaxone (50mg-100mg/kg up to 2g
daily) +
Metronidazole
Culture
Blood, urine, sputum, throat
swab etc.
4
3

17. Control
Inflammation
Steroids
Hydrocortisone 2-6g daily for 2
days
NSAIDS
Ibuprofen , Paracetamol
Activated C Protein
Treat coagulation
Glycemic Control
maintain at 80-120 mg/dL
5

18. Eliminate Septic focus
• Drainage of abscess
• Resection of gangrenous
bowel
• Wound excision
• Laprotomy for peritonitis
6