Septic shock

SEPTIC SHOCK : DIAGNOSIS

AND TREATMENT

- Anira Iqbal

3 Stages

Sepsis – Infection in blood + Inflammation in body

Severe sepsis – Organ failure + Blood clots (Gangrene)

Septic shock – BP drops + MOF

Diagnosis - What stage?

• Bacteria in blood

• Clotting of blood in blood vessels• Dec O2sat levels • Inc waste products in blood• Abnormal liver and kidney functions• Electrolyte imbalance

• BP not corrected by fluid admin.

SEPSIS

SEVERE SEPSIS

SEPTIC SHOCK

Tests1. Blood test – Culture Lactic acid level Platelets O2 level2. Urine test – Infection3. Wound secretion test4. Mucus secretion test5. CSF test 6. Indwelling catheter – sample

from lumen7. PCR – Microbial DNA in

blood/tissue

Still unconfirmed :1. X-ray (Lung)2. CT (Appendix,

pancreas, bowel)3. USG (GB, ovary)4. MRI (Soft tissue

abscess)

Treatment : General Measures

Airway – IntubationBreathing – Mechanical ventilationCirculation – Fluids

Septic shockLA in bloodMetab acidosis Respiratory alkalosisHyperventilationMechanical ventilation + sedationdec O2 demand of resp muscles inc O2 delivery to hypoperfused tissues

Unresponsive patient?? Check glucose Low 1 ampoule of 50% dextrose iv

Treatment :Specific measures

1. Remove source of infection2. Control infection – iv Antibiotics3. Inc BP – iv fluids Vasopressor agents4. Inflammation – Corticosteroids5. Inc O2 sat – Respirator6. Remove waste products – Dialysis7. Remove infected tissue – Surgery8. Packed RBC transfusion – if Hb<7gm/dl

Antibiotics

As soon as blood sample taken for culture Gram positive + Gram negative org After culture reports, specific therapy Usually, monotherapy preferred over combination Exception – Pseudomonas aeruginosa – AG + Beta-L

Vasoactive therapy1. Norepinephrine iv infusion – Inc MAP2. Epinephrine – Severe shock3. Dopamine – Low dose – D, beta agonist – Inc GF, inc

HR, Inc cardiac contractility. High dose – alpha agonist – Peripheral vasoconstriction

4. Vasopressin – R on Smooth muscle cells – Periph VC + potentiates effect of catecholamines

CorticosteroidsLow dose 1. Hydrocortisone2. Alpha-Fludrocortisone

Activated Protein C (Drotrecogin-alpha) – Antithrombotic, Profibrinolytic, antiinflammatory

PrognosisSevere sepsis – 20 – 35% dieSeptic shock – 40 - 60% die

APACHE II (Acute Physiology and Chronic Health Evaluation II) : is a severity-of-disease classification system.AgeTemperature (rectal)Mean arterial pressurepH arterialHeart rateRespiratory rateSodium (serum)Potassium (serum)CreatinineHematocritWhite blood cell countGlasgow Coma Scale

Prevention

Dec no. of invasive procedures Limit use of catheters More aggressive treatment of nosocomial infections Avoid indiscriminate use of corticosteroids and Antibiotics

THANK YOU!!

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