concise ppt on septic shock,

1. Septic shock

2. Sepsis and
Septic shock
– Sepsis has been defined as life – threatening organ dysfunction
caused by a dysregulated immune response of the host to infection.
– Recent definitions have specified that septic shock is a subset of
sepsis, in which the circulatory and metabolic/cellular
abnormalities are profound enough to substantially increase
mortality risk.

3. SOFA and
qSOFA

4. Definitions

5. Etiology of
sepsis
Septic shock may be caused by gram positive (most common) ,
gram negative bacteria or fungi.
The common gram positive bacteria include :
• Staphylococcus aureus
• Enterococci
• Streptococcus pneumoniae

6. Pathogenesis of
Septic shock

7. Continuum of
severity of
Sepsis
Infection, inflammation, trauma
SIRS
Sepsis
Severe Sepsis
SHOCK

8. Principles of
sepsis
management
– Recognise sepsis early and determine severity
– Early antibiotics are critical to resolution of shock
– Resuscitate severe sepsis and septic shock as soon as possible
– Early goal directed therapy

9. Elements of
sepsis
management
– Resuscitate
– Infection control
– Respiratory support
– General supportive care

10. RESUSCITATION
– Initial resuscitation: volume resuscitation with normal saline 30
mL/kg over first 30 minutes. If mean arterial pressure is >70mm
Hg, inotropes can be started.
• Fluid therapy: crystalloids are used first
• Vasopressors: it is initiated if appropriate fluid therapy fails to
restore adequate blood pressure and organ perfusion.
Norepinephrine or Dobutamine is the first line agent to correct
hypotension in septic shock.
• Blood product administration: it should be given only when
Haemoglobin drops to <7 g/dL.

11. INFECTION
CONTROL
• Diagnosis:
oObtaining blood cultures
oOther cultures such as urine, CSF, wounds, respiratory fluids as per
the clinical situation
oOther diagnostic studies such as imaging and sampling
• Antibiotic therapy: Intravenous antibiotic therapy should be
started within first hour of recognition of severe sepsis, after
obtaining appropriate cultures.
– Source control :
oDrainage
oDebridement
oInfected device removal

12. RESPIRATORY
SUPPORT
– A target tidal volume of 6 mL/kg of predicted body weight
(compared with 12 mL/kg in adult patients) is recommended in
sepsis-induced ARDS.
– Mechanical ventilation:
oSepsis induced acute lung injury (ALI)/ ARDS

13. GENERAL
SUPPORTIVE
CARE
– Steroids: Intravenous hydrocortisone 200-300 mg/day for 7 days in
three or four divided doses or continuous infusion.
• Glucose control
• Renal replacement should be used in patients with sepsis and
acute kidney injury
• DVT prophylaxis
• Stress ulcer prophylaxis : H2 receptor blockade

14. THANKYOU!