SEPTIC SHOCK

2.  It occurs due to sepsis and
leads to a major decrease in
tissue perfusion to organs and
tissues.

3.  is a continuum widespread
infection in bloodstream
(Bacteremia)
 Gram
positive or
gram negative
bacteria

4. Serum Lactate > 2
mmol/L
Need vasopressors
to maintain perfusion
Persistent
hypotension < 90
SBP
1
3
2

5. PATHOGENESIS OF SEPTIC
SHOCK
Microorganism triggered
by gram positive or gram
negative bacilli
Substances from
these
microorganisms
Macrophages,
neutrophils, dendritic
cells, endothelial
Septi
c
shoc
k
Orga
n
Death

6. A. Clients with immune weakened
system
• HIV/AIDS
• Malnutrition
• Pregnant woman
• Infants
• Elderly
• Treatments
(immunosuppressive
therapy,
chemotherapy)

7. B. Indwelling medical devices
C. Chronic diseases
• Diabetes mellitus,
kidney/liver disease
• Urinary
catheter
• Central line

8. E. Surgical procedures
(anything invasive)
D. Prolonged hospitalization

9. • Warm, flushed skin
• Decreased blood
pressure
• Hyperthemia
Early stage “Warm phase”

10. • High cardiac
output
• Decreased
systemic
vascular
Heart
rate
Respi
rate
• Tachycardia
• Tachypnea

11. • Skin pale, cold, clammy
skin
Late stage “Cold phase”
• Severe hypotension

12. • Hypothermia
• Depressed heart function
• Oliguria
• Coma
< 30 ml

13. • Renal failure
• Respiratory failure
• Cardiac failure
• Metabolic acidosis
• Disseminated Intravascular
Coagulation

14. • Blood
culture
• Complete blood count:
Anemia, leukopenia,
neutropenia,
thrombocytopenia

15. • BUN elevated and
creatinine decreased
• Arterial Blood Gases
• Invasive hemodynamic
monitoring

16. • Impaired Gas Exchange
related to interference with
oxygen delivery
•Risk for shock related to
infection
• Risk for decreased cardiac
output related to decreased
preload
• Risk for deficient fluid volume
related to massive vasodilation

17. • Start antibiotics: Broad-
spectrum antibiotics are
given until organism is
identified
• Enteral nutrition and
may need prophylactic
drugs like Famotidine as
well

18. • Protein Activated C: “Drotrecogin
Alpha”
• Titrate vasopressors (Norepinephrine 1st
choice)
 used when fluid replacement is
unsuccessful
• Inotropics (Dobutamine)

19.  Normal (0.9%)
Saline
 Ringer’s Lactate
Solution (Hartmann’s
Solution)
 5% Dextrose
• Crystalloids
Fluids
• Colloids Fluids
 Human
Albumin
 Gelatin
Solution
 Dextran
 Used as first initial treatment

20. • Corticosteroids
• Hemodynamic
monitoring
• Oxygenate
• Check lactate levels
• Foley insertion