What is septic shock? Septic shock is the situation in which the blood pressure dangerously and in result of wide-body infection is reduced. Therefore, in result of the presence of the bacteria in the blood, or bacteremia septic shock may happen. When the toxins produced by bacteria is released into the blood the immune system responds, which leads to a blood pressure reduction, in order to prevent the delivery of the toxins to the vital organs. Generally, in result of septic shock multiple organ failure may happen, such as respiratory failure that may lead to rapid death.
Pathophysiology of Septic Shock
As the infection spreads in the blood, endotoxins are produced, and released in the bloodstream. Endotoxins are complex molecules, which are dramatically responded by the immune system. The release of endotoxins in bloodstream is highly dangerous, because they can widely diffused in the body, and in addition, they can affect the blood vessels, themselves. They can dilate the arteries and arterioles, which in result increases the total volume of the circulatory system. After the dilation of the blood vessels the leakage of the fluid into the tissue, which results in the reduction of the circulating fluid in the system. So endotoxins from one side increase the total volume of the circulatory system, and from the other side reduce the amount of the fluid in the system, therefore, in can cause a quick, and dramatic drop of blood flow to the organs. In addition, the respond of the immune system may cause blood coagulation in extremities, which also decreases the circulation of blood flow to the organs. Therefore, as we can see the intoxication by multiple mechanisms causes a severe reduction of blood flow to the vital organs which results in multiple organ failure, and finally death.
Causes of Septic Shock:
As we already mentioned septic shock, happens when there is an infection in blood stream, but when the infection can find such a chance to spread in the blood stream? In most of the cases, the patient has a suppressed immune system. For example, the immune system of the patients suffering from cancer is severely suppressed in result of treatments, patients suffering from autoimmune disorders, or diseases such as AIDS, or the patients, which have had organ transplantation.
As other causes of septic shock, we can mention:
- Diabetes
- Diseases of the genitourinary system, biliary system, or intestinal system
- Leukemia
- Long-term use of antibiotics
- chronic drug abuse
- malnutrition
- Lymphoma
- Recent infection
- Recent surgery or medical procedure such as using catheters, or intravenous equipment.
- Recent use of steroid medications
Basic Life Support (BLS) Treatment
Keep the patient warm
Oxygen by non-rebreather mask at 15 lpmAdvanced Life Support (ALS) Treatment
High flow of oxygen by using NRB (non-rebreather mask) or Tracheal intubation.
IV of NS fluid challenges in 200 ml increments for hemodynamic stabilization.
Dopamine to support blood pressure.
Heart monitor applied, and medications administered to correct dysrhythmias.
Treatment of Septic Shock
Treatment of septic shock is an emergency so in most cases the patients are transferred to the intensive care unit of the hospital. The very first things that must be balanced are; the respiratory distress, amount of fluid circulating in the body, and the blood pressure. The respiratory distress must be treated by using Breathing machine (mechanical ventilation) and supplemental oxygen. The amount fluid lost by leakage is substituted by intravenous fluids such as, blood or protein solutions. As we have mentioned the main reason of septic shock is the presence of bacteria in the blood stream, therefore, wide spectrum antibiotics are used simultaneously, and sometimes even two or three different types, until the exact type of infection is identified and the appropriate antibiotic is used. Also for increasing the blood pressure, vasopressors such as dopamine or norepinephrine are used. Plasma or platelets can also be transfused to treat hemorrhage and/ or coagulation. Hemodialysis is one of the other options that might be needed for treatment to remove the toxins from blood in a much shorter period.
All these mentioned treatments are basically, the primary treatments to keep the patient alive as in result of the shock the vital organs have failed, but the main treatment is targeting the main pathogen causing the sepsis. Therefore, removing the main pathogen, by surgical methods such as drainage, or removal of the infected foci might be essential, parallel to the treatment of the complications. Therefore, we can say that the most essential part of sepsis management is source control.
References:
Septic shock. (n.d.). TheFreeDictionary.com. Retrieved October 13, 2014, from http://medical-dictionary.thefreedictionary.com/septic+shock
Septic shock: MedlinePlus Medical Encyclopedia. (n.d.). U.S National Library of Medicine. Retrieved October 13, 2014, from http://www.nlm.nih.gov/medlineplus/ency/article/000668.htm
Septic Shock Treatment & Management. (n.d.). Septic Shock Treatment & Management. Retrieved October 13, 2014, from http://emedicine.medscape.com/article/168402-treatment#a1156
