Septic shock
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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
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Septic shock
- 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
- 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