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SEPTIC SHOCKSEPTIC SHOCKA serious condition that occurs when a body-wide infection leads to dangerously low blood pressureSeptic ShockFirst: 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 onblood gas, PCO2 less than 32 mmHg signifying hyperventilation.White blood cellcount either significantly low, < 4000 cells/mm3or elevated > 12000 cells/mm3Heart rate> 90 beats per minuteTemperature:Fever> 38.0C (100.4F) or hypothermia < 36.0C (96.8F)SEPTIC SHOCKSecond: Sepsis requires evidence of infection,.Third: signs of end-organ dysfunction Finally, septic shock is diagnosed if there is refractory hypotensionPathophysiology 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

Risk FactorsHealth care associated infxnAntibiotic resistant microorganismSurgical and invasive proceduresMalnutrition/immunosuppressionChronic illness: DM, hepa, CRF etc.Traumatic injuries: burns, abcess etc.CausesGram (-) bacteria (Escherichia, Klebsiella, Pseudo)Gram (+) bacteria (Stapph)Fungal infxn- 3%AURI- 25%UTI- 25%Soft tissue infxn- 15%INCIDENCE RATEAging population.Drug-resistant bacteria..Weakened immune systems.

Gender, ethnic, life span considerationsElderly pt- immunocompromised due to agingNeonates-immature immune system:poor feeding, activity levelsStages of shockFINDINGCompensatoryProgres-siveIrreversibleBPNormalSystolic 80-90 mmhgMechanical/pharmacological supportHR>100 bpm>150 bpmasystoleRR>20 breaths/minRapid, shallowIntubation/mechanical ventilationSkinCold. ClammyMottled, petechiejaundiceUODecreased0.5 ml/kg/hanuricMenationConfusionlethargyunconsciousAcid Base BalanceRespiratory alkalosisMetabolic alkalosisProfound acidosisExams and TestBlood testsUrine Analysis.Wound secretions.Respiratory secretions.Imaging scansX-ray.Computerized tomography (CT).Ultrasound.Magnetic resonance imaging (MRI).

Medical ManagementPrimary goals:Maintain O2 delivery to the tissues & restore vascular volume, BP & COPromote fluid balance and cardiac outputIV fluids: (LR , NSS, D5WVasopressors ( dopaminePlasma expanders- dextran, mannitolWhole blood and blood products13Medical ManagementAssist with cardiac supportPosition: Modified Trendelenburg

Medical Management2. Intraaortic balloon 3. Medical Anti- pumpshock trouser

Medical ManagementAssist with respiratory supportOxygen therapySuctionMechanical vent- PEEP for ARDS Acute respiratory distress syndrome

Medical ManagementAssist with renal failureMonitor hourly urine, BUN, CreaFurosemide, urea and mannitolDobutamineMedical ManagementAssist with GI supportInsert NGT. Connect NGT to low suction2. Antacids, Antihistamines

Medical ManagementPromote SafetyPrevent falls.Protect from infxn and chillsPrevent complication of immobilityNursing ManagementMaintain ABCStrict aseptic technique pt. ComfortPreventing injurySupporting & educating pt. FamilyMaintain skin integrity

PrognosisSeptic 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.