What is septic shock?
The definition of septic shock is ever changing as the medical community learns more about how the body fails in the face of overwhelming infection. The Society of Critical Care Medicine and the European Society of Intensive Care Medicine agreed upon the most recent definitions in 2017.
Sepsis is a life-threatening bacterial infection that causes a generalized inflammatory response in the body that affects the immune system and causes it to not respond properly to the infection. This may result in the failure of the body's organs.
The formal definition of sepsis: "life-threatening organ dysfunction caused by a dysregulated host response to infection." The SOFA score (sequential sepsis related organ failure assessment -- a scoring system to assess and track a patients severity of sepsis) needs to be 2 or more.
Septic shock is a worsening of sepsis and hypotension (low blood pressure) requiring medications (vasopressors) to increase blood pressure into the normal range and elevated lactate levels in the blood (lactate is a measure of waste products on the blood) define it. Vasopressors are intravenous medications that are continuously infused that increase blood pressure by narrowing arteries and increasing the heart's pumping capabilities.
The formal definition of septic shock: "circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. These patients can be clinically identified by a vasopressor requirement to maintain a MAP ≥ 65mmHg and serum lactate >2mmol/L in the absence of hypovolemia."
The quick SOFA score (qSOFA) measures blood pressure, respiratory rate, and Glasgow Coma Scale).
Doctors do not understand the exact mechanism as to why sepsis and septic shock occur.
What causes septic shock?
Bacterial infections that invade the body and overwhelm the immune system cause sepsis and septic shock.
Risk factors for developing septic shock include the following:
- Patients at extremes of age, including the elderly and the very young
- Those with underlying medical illnesses like diabetes, liver disease, kidney disease, or cancer
- Patients with immune compromise: This may include those on chemotherapy or other medications that affect the body's ability to fight infection.
- IV drug users
- Delay in making the diagnosis of an infection
- Delay in starting antibiotic treatment increases the risk of developing sepsis
What are the symptoms of septic shock?
Patients in septic shock are critically ill. In addition to the signs and symptoms of the underlying infection, they may also have
Diagnosis of septic shock
An initial diagnosis begins with the care provider taking a history and performing a physical exam to try to find the source of the infection. Because these patients are critically ill and unstable, the history and physical often occur at the same time as medical professionals take blood tests and X-rays, and start the patient on intravenous fluids.
Searching for the source of infection may include getting a urine sample and chest X-ray. Other X-rays and CT scans will depend upon where the search for the source of infection takes the provider and patient.
Medical professionals perform blood cultures and urine cultures to try and identify the type of bacteria causing the infection.
Your doctor may perform a lumbar puncture to obtain a sample of cerebral spinal fluid if there is concern for meningitis or encephalitis. Medical professionals will then culture the cerebral spinal fluid.
What are treatments for septic shock?
The initial treatment for septic shock incorporates the ABCs of resuscitation (airway, breathing, circulation). Patients in septic shock need to be admitted to an intensive care unit for treatment. This may include intubating the patient and using a ventilator to help with breathing.
Intravenous fluids support blood pressure. By definition, for it to be septic shock, a vasopressor medication (for example, dopamine, dobutamine, epinephrine, norepinephrine) also needs to be required to help elevated blood pressure.
Early intravenous antibiotics are important to fight the underlying infection and empiric broad spectrum antibiotic therapy is recommended. Even if the source of infection is known, the type of bacteria, and how susceptible it might be to a specific antibiotic is not. For that reason, your doctor will start you on multiple antibiotics, and as test results return, only those antibiotics that work against a specific infection will be continued.
The cause of the original infection, as well as what organs are failing, will determine other treatment options.
What are the complications of septic shock?
By definition, septic shock requires that various organs in the body fail to work. These include the heart, lungs, liver, and kidneys among others. If the infection cannot be controlled and treated, at the same as vital signs are being restored (circulation and breathing), the patient may die.
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