Uploaded byAshok Kanuri
Septic shock
Septic shock is defined as infection combined with systemic inflammatory response syndrome that causes inadequate organ perfusion and progressive organ dysfunction. It is usually caused by bacterial infection spreading from a site of infection into the bloodstream. Diagnosis involves identifying signs of infection and organ dysfunction. Treatment focuses on supporting vital organ functions through respiratory support, circulatory support through fluid resuscitation and vasopressors, administering antibiotics, and treating any underlying infections through drainage or surgery. Prognosis depends on early diagnosis and treatment of infections before organ damage becomes irreversible.
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Septic shock
- 1. SEPTIC SHOCK ASHOK KANURI ANDHRAMEDICAL COLLEGE VISAKHAPATNAM
- 2. DEFINITION INFECTION +SIRS with evidence of inadequate perfusion to major organs with progressive failure of organ systems function SEPTICEMIA – A state of microbial invasion from a portal of entry into blood stream which causes signs of illness BACTEREMIA – Presence of bacteria in the liquid component of blood MODS – Presence of altered organ function in acutely ill in whom homeostasis cannot be maintained without intervention SIRS-Systemic Inflammatory Response Syndrome MODY-Multi Organ DYsfunction
- 3. SIRS If atleast 2out of 4 are present Temperature- > 38 <36 deg celsius Heart rate >90/min Respiratory rate >20/minute, paCO2 32 mmHg WBC >12000/µl < 4000/µl or 10% immature forms
- 4.
- 5. PATHO-PHYSIOLOGY Local Infection Activation of host defense mechanisms Increase neutrophils, monocytes Inflammatory mediators Local vasodilatation Increased permeability Increased coagulopathy diffuse endothelial damage vascular permeability and dilatation thrombosis of end organ capillaries
- 6. ETIOLOGY Single/multiple foci ofinfection Lower respiratory tract- 25% Urinary tract infections-25% Soft tissue infections-15% Gastro intestinal tract-15% Reproductive tract infections-10% Foreign bodies-5% Miscellaneous-5%
- 7. EPIDEMIOLOGY Low socio-economicstatus and decreased accessibility to quality health care Age extremes <10 years > 70 years Sex - Men > Women Predisposing factors Malignancy Chronic liver disease Chronic renal failure Immunosuppression, Diabetes, HIV Pregnancy, Abortion, Malnutrition Surgery, Trauma, Burns, Catheters
- 8. CLINICAL PRESENTATION Head& Neck- head ache, neck stiffness, altered mental status, ear ache, sore throat, mandibular or cervical lymph node enlargement Abdominal- Nausea, Vomiting, Diarrhea Pelvic & GUT- flank pain, pelvic pain, vaginal/ urethral discharge, dysuria Bone & soft tissue-Limb pain, focal erythema, edema, swollen joints Skin-gray mottled Other- fever with chills and rigor, fatigue, malaise
- 9. Physical Examination Ina case of dropping vitals + signs of hypoperfusion Look for A B C See for foci of Infection Record rectal temperature Observe the skin color Narrow pulse pressure and Tachycardia is the earliest sign of shock
- 10. Septic shock Clinicalmarkers of progression to septic shock( at least 1) Alteration in mental status Hypoxemia Pao2 < 72 mm Hg Increased plasma lactate Oliguria (< 0.5 ml/kg for at least 1 hour)
- 11. May also presentwith complications Acute lung injury progressing to ARDS Acute renal failure Disseminated Intravascular Coagulation Mesenteric Ischemia Myocardial Infarction Liver failure Neurologic and cognitive sequalae ARDS- Acute Respiratory Distress Syndrome
- 12. DIAGNOSIS Complete Blood picture& Differential counts fever + signs of infection with leucocyte counts > 15000/µl, neutrophil band count > 1500/µl Low Hb is associated with bad prognosis Platelets increase and later fall due to DIC Blood biochemistry Coagulation studies Blood culture Urinalysis
- 13. DIAGNOSIS Grams staining Culture of secretions Radiology – chest ,abdomen , extremities Ultrasound CT MRI Lumbar puncture Others- BP, Pulse oximetry, Echo cardiogram
- 14. TREATMENT A BC Respiratory support : Airway patency, O2, ventilation. Circulatory support : Crysralloid(20-30ml/kg), NS/RL. Anti- microbials : Emperical, later based on culture.
- 15. TREATMENT Temperature control: Antipyretic, physical cooling. Metabolic support : Tight glycemic control, electrolyte imbalance. Anemia & coagulopathy correction Monitoring renal function
- 16. TREATMENT Nutritional support: Enteral, later TPN, glutamine rich diet. Surgical : abscess drainage
- 17. Summary of medications Vasopressors – nor epinephrine, dopamine, dobutamine, vasopressin, phenylephrine, epinephrine Isotonic crystalloids- normal saline, ringer lactate Colloids- albumin Antibiotics- cefotaxime, ticaricillin,piperacillin,vancomycin Corticosteroids- hydrocortisone, dexamethasone Human activated protein C- drotrecogin-alpha
- 18. DIFFERENTIAL DIAGNOSIS Acuterenal failure Adrenal crisis Cardiogenic shock Diabetic keto acidosis DIC Heat stroke Hypovolemic shock Myocardial Infarction Neuroleptic malignant syndrome
- 19. Pulmonary embolism Toxic shock syndrome Salicylate toxicity transfusion reaction Shock and pregnancy
- 20.