SEPTIC SHOCK

SEPTIC SHOCK
A serious condition that occurs when a
body-wide infection leads to dangerously low
blood pressure
Septic Shock
First: SIRS (systemic inflammatory response syndrome)
must first be diagnosed by finding at least any two of
the following:
Tachypnea (high respiratory rate) > 20 breaths per
minute, or on blood gas,
PCO2 less than 32 mmHg signifying hyperventilation.
White blood cell count either significantly low, < 4000
cells/mm
3
or elevated > 12000 cells/mm
3

Heart rate > 90 beats per minute
Temperature: Fever > 38.0 C (100.4 F) or hypothermia
< 36.0 C (96.8 F)
SEPTIC SHOCK
Second: Sepsis requires evidence of infection,.
Third: signs of end-organ dysfunction
Finally, septic shock is diagnosed if there is
refractory hypotension
Pathophysiology
Development of local infection

Bacteria enter the systemic circulation and
release toxins in the bloodstreams

Gram(-) release endotoxins,
Gram(+) release exotoxins



Pathophysiology
Causes massive vasodilation

Blood flow becomes sluggish, tissues become
hypoxic and acidosis develops

Major organs fail(lungs, liver, kidney, blood coagulation)

Multiple organ dysfunction syndrome

Health care associated infxn
Antibiotic resistant microorganism
Surgical and invasive procedures
Malnutrition/immunosuppression
Chronic illness: DM, hepa, CRF etc.
Traumatic injuries: burns, abcess etc.
Causes
Gram (-) bacteria (Escherichia, Klebsiella,
Pseudo)
Gram (+) bacteria (Stapph)
Fungal infxn- 3%
AURI- 25%
UTI- 25%
Soft tissue infxn- 15%
INCIDENCE RATE
Aging population.
Drug-resistant bacteria. .
Weakened immune systems.


Gender, ethnic, life span
considerations
Elderly pt- immunocompromised due to
aging
Neonates-immature immune system
:poor feeding, activity levels
Stages of shock
FINDING Compensatory Progres-sive Irreversible
BP Normal Systolic 80-90
mmhg
Mechanical/pharma
cological support
HR >100 bpm >150 bpm asystole
RR >20 breaths/min Rapid, shallow Intubation/mechani
cal ventilation
Skin Cold. Clammy Mottled, petechie jaundice
UO Decreased 0.5 ml/kg/h anuric
Menation Confusion lethargy unconscious
Acid Base
Balance
Respiratory alkalosis Metabolic alkalosis Profound acidosis
Exams and Test
Blood tests
Urine Analysis.
Wound secretions.
Respiratory secretions.
Imaging scans
X-ray.
Computerized tomography (CT).
Ultrasound.
Magnetic resonance imaging (MRI).

Medical Management
Primary goals:
Maintain O2 delivery to the tissues & restore
vascular volume, BP & CO
1. Promote fluid balance and cardiac output
IV fluids: (LR , NSS, D5W
Vasopressors ( dopamine
Plasma expanders- dextran, mannitol
Whole blood and blood products
Medical Management
Assist with cardiac support
1. Position: Modified Trendelenburg
Medical Management
2. Intraaortic balloon 3. Medical Anti-
pump shock trouser

Medical Management
Assist with respiratory support
1. Oxygen therapy
2. Suction
3. Mechanical vent- PEEP for ARDS
Acute respiratory
distress syndrome

Medical Management
Assist with renal failure
1. Monitor hourly urine, BUN, Crea
2. Furosemide, urea and mannitol
3. Dobutamine
Medical Management
Assist with GI support
1. Insert NGT. Connect NGT to low suction
2. Antacids, Antihistamines

Medical Management
Promote Safety
1. Prevent falls.
2. Protect from infxn and chills
3. Prevent complication of immobility
Nursing Management
1. Maintain ABC
2. Strict aseptic technique
3. pt. Comfort
4. Preventing injury
5. Supporting & educating pt. Family
6. Maintain skin integrity

Prognosis
Septic shock has a high death rate. The death
rate depends on the patient's age and overall
health, the cause of the infection, how many
organs have failed, and how quickly and
aggressively medical therapy is started.