Lecture Notes: Septic Shock

Introduction

• Lecturer: Sarah, RegisteredNurseRN.com
• Topic: Septic Shock as part of a series on shock.
• Importance of recognizing early signs to prevent progression to septic shock.

What is Septic Shock?

• Definition: A severe condition resulting from sepsis, causing major decrease in tissue perfusion.
• Result: Leads to hypoxic injury and potential cell death if untreated.
• Sepsis: An invasion of the body by microorganisms (bacteria, fungus, virus, parasite) leading to systemic inflammatory response.

Pathophysiology

• Primary issue: Impaired blood distribution due to microorganism-triggered vascular damage.
• Inflammatory Response: Overactive immune response leading to vessel damage.
  • Vasodilation: Causes blood pooling and decreased systemic vascular resistance.
  • Increased Permeability: Leads to fluid leakage into tissues, causing hypovolemia.
  • Clotting: Formation of microclots due to platelet activating factors, risking DIC (Disseminated Intravascular Coagulation).
  • Myocardial Impact: Cytokines can decrease heart function, particularly ejection fraction.

Risk Factors

• Mnemonic: SEPSIS
  • S: Suppressed immune system (HIV, chemotherapy, etc.).
  • E: Extreme age (infants and elderly).
  • P: Post-operative or post-transplant patients.
  • S: Surgical procedures and indwelling devices (risk of microorganism introduction).
  • I: Illness (chronic conditions like diabetes, renal insufficiency).
  • S: Sites of infection (GI, respiratory, urinary tract).

Signs and Symptoms

• Early Signs:
  • Warm, flushed skin
  • Low blood pressure, high heart rate, high respirations
  • Fever and high cardiac output
  • Restlessness, anxiety
• Late Signs:
  • Cold, clammy skin
  • Severe hypotension, decreased cardiac output
  • Oliguria (low urine output)
  • Altered mental status, coma
  • Hypothermia

Treatment and Nursing Interventions

• Goals: Increase tissue perfusion, oxygenation, and reverse vasodilation and inflammation.
• Fluid Replacement: Large quantities initially, followed by vasopressors if unsuccessful.
• Antibiotics: Administer within the first hour, after obtaining cultures.
• Vasopressors: Norepinephrine to increase systemic vascular resistance.
• Oxygenation: Maintain oxygen saturation above 95%.
• Nutrition: Early enteral feeding to preserve GI integrity.
• Control Blood Glucose: Prevent hyperglycemia with insulin drips.
• Monitor Serum Lactate: Indicators of tissue perfusion issues.
• Hemodynamic Monitoring: Using central venous and arterial catheters to assess pressures.

Nursing Mnemonic: SEPTIC SHOCK

• S: Start antibiotics within first hour.
• E: Enteral nutrition early.
• P: Protein activated C to reduce inflammation and clotting.
• T: Titrate vasopressors for MAP >65 mmHg.
• I: Inotropics like dobutamine to strengthen heart contractions.
• C: Crystalloids/colloids for initial treatment.
• S: Steroids for inflammation.
• H: Hemodynamic monitoring in ICU.
• O: Oxygenate to maintain saturation >95%.
• C: Cultures before antibiotics.
• K: Keep glucose <180 mg/dL.

Conclusion

• Importance of monitoring and early intervention to prevent progression to septic shock.
• Encouragement to take the free quiz and subscribe for more educational content.