Septic Shock: Diagnosis, Treatment, and Monitoring

Overview

• Septic shock: Infection in the bloodstream leading to a severe immune response.
• Initial response: WBCs release immune molecules causing damage and increased permeability and diameter of blood vessels.

Diagnosis

Symptoms to Watch For

• Fevers, chills, sweating, flushed appearance
• Dropping blood pressure

Diagnostic Steps

1. Vital signs: Check temperature and other vital signs.
2. Blood cultures: Identify infective material (fungus, bacteria, virus).
3. Severity assessment: Measure serum lactate, arterial blood gas (ABG), BUN, and Creatinine.
   • Serum Lactate: Indicates tissue perfusion and anaerobic metabolism.
   • ABG: Measures oxygen, carbon dioxide levels in the blood.
   • BUN & Creatinine: Assess kidney function and detect early damage due to lack of oxygen.

Treatment

• Prompt treatment: Reduces mortality.
• Broad spectrum antibiotics: To address a wide range of infections initially.
  • If patient shows no improvement, consider anti-fungals.
• IV fluids: To restore blood pressure.
• Pressors: Medications used to increase systemic vascular resistance and blood pressure.
• Tailored therapy: Based on blood culture results.

Key Points

• Always draw blood cultures before starting antibiotics to avoid interfering with culture growth.
• Treatment should not be delayed as it can lead to increased mortality.
• Use of two large bore IV lines may be necessary for rapid fluid infusion.

Monitoring Progress

• Repeated lactate, ABG, BUN, and Creatinine tests to track improvement.
• CRP and ESR: Track inflammation.
  • Normal CRP: <1 mg/dL; normal ESR: <20-25 mm/hr depending on age.
  • Elevated in septic shock, should decrease as condition improves.

Final Points

• Diagnosis, treatment, and monitoring are crucial.
• Immediate blood cultures, followed by antibiotics.
• Ensure rapid administration of IV fluids via large bore IV lines.