Septic Shock

  • Definition

    Sepsis is a systemic inflammatory response to a severe infection. The inflammatory response triggers a rapid cascade of events, such as leaking blood vessels and impaired blood flow.
    Severe sepsis is associated with a drop in blood pressure. Low blood pressure reduces the amount of oxygen and nutrients going to the body's organs. This drop causes damage the body's major organs.
    Septic shock occurs when adequate blood pressure can't be restored despite treatment with IV fluids. Septic shock may lead to multiple organ failure and death.
  • Causes

    Septic shock is caused by an infection that overwhelms the body. Sepsis can be triggered by many different kinds of infections including:
    • Bacterial—most common
    • Fungal infections
    • Viral
    • Parasitic
    Lung sepsis infant
    An infection of the lungs has spread throughout the body, leading to septic shock.
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  • Risk Factors

    Septic shock is more common in infants and in people over 50 years old. Other factors that may increase your chance of septic shock include:
    • Weakened immune system
    • Absence of your spleen
    • Cancer
    • Low white blood cell counts
    • Chronic diseases
    • Previous surgery
  • Symptoms

    Septic shock may cause:
    • Fever, which may be followed by a drop in body temperature to below normal
    • Warm, flushed skin
    • Chills
    • Rapid, pounding heartbeat
    • Rapid breathing
    • Confusion
    • Reduced alertness
    • Irregular blood pressure
    • Reduced urination
    Complications from septic shock may cause symptoms of:
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done.
    Tests may include the following:
    • Complete blood tests to assess white blood cell counts, inflammatory markers, oxygen levels, and kidney function
    • Cultures to check for infectious organisms
    • Electrocardiogram (EKG) to check for heart rhythm irregularities
    • Imaging tests may be used to look for specific sources of infection, such as pneumonia
  • Treatment

    Sepsis and septic shock require immediate care. Treatment includes the following:
    Supportive Measures for Shock
    If you have septic shock, you will be admitted to the intensive care unit. There you will be given:
    • IV fluids
    • Medications to increase blood pressure and blood flow to your organs
    • Extra oxygen
    • Corticosteroids may be needed to reduce the inflammatory response, especially if fluids aren't working
    If your lungs fail, you may be put on a mechanical ventilator to help you breathe. Other therapies or supportive measures may be used.
    Medications
    Once the cause of the infection is identified, you will be given high doses of one or more antibiotics or antifungals.
    Surgery
    Surgery may be performed to remove any dead tissue.
  • Prevention

    Most cases of septic shock cannot be prevented. Treating bacterial and other infections promptly may help.
  • RESOURCES

    Centers for Disease Control and Prevention http://www.cdc.gov

    Society of Critical Care Medicine http://www.sccm.org

    CANADIAN RESOURCES

    Canadian Association of Emergency Physicians http://www.caep.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Behrman RE, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders; 2007.

    Dellinger RP, Levy MM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580-637.

    Goldman L, Ausiello D, eds. Cecil Textbook of Internal Medicine. 23rd ed. Philadelphia, PA: Saunders; 2008.

    Marx JA, et al. Rosen's Emergency Medicine.7th ed. St. Louis, MO: Mosby, Inc.; 2009.

    Sepsis and septic shock. Merck Manual of Diagnosis and Therapy website. Available at: http://www.merckmanuals.com/professional/critical%5Fcare%5Fmedicine/sepsis%5Fand%5Fseptic%5Fshock/sepsis%5Fand%5Fseptic%5Fshock.html?qt=septic shock&alt=sh. Updated July 2013. Accessed December 30, 2013.

    Sepsis fact sheet. National Institute of General Medical Sciences website. Available at: http://www.nigms.nih.gov/Education/Pages/factsheet%5Fsepsis.aspx. Updated November 2012. Accessed December 30, 2013.

    Sepsis in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 28, 2013. Accessed December 30, 2013.

    Sepsis treatment in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 28, 2013. Accessed December 30, 2013.

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