**6. Septic shock**

It is the most common form of distributive shock. The body's defense system is overwhelmed by infection leading to life-threatening organ dysfunction. In resuscitating septic shock, few effects should be considered: hypovolemia, cardiovascular depression, and systemic inflammation. Besides, there is capillary leak, which causes intravascular volume loss. The combined interaction of chemical mediators, inflammation, and disturbed metabolism causes heart injury during septic shock. There is also capillary leak in the lungs, presenting as acute respiratory distress syndrome (ARDS) [2].

Common causative organisms are pneumococcus, methicillin-resistant *Staphylococcus aureus* (MRSA), *Klebsiella pneumoniae*, *Pseudomonas aeruginosa*, etc. [4].

**Septic shock**:

**Figure 4.** Steps of sepsis [6].

6 h [5].

**SIRS** with suspected infection and hypotension, despite adequate fluid resuscitation [5].

The latest **Surviving Sepsis Campaign Bundles** are as follows:

**2.** Obtain blood cultures prior to administration of antibiotics.

**4.** Administer 30 ml/kg crystalloid for hypotension or lactate ≥4 mmol/L [5].

To be completed 3 h of time of presentation:

**3.** Administer broad spectrum antibiotics.

To be completed within 6 h of time of presentation:

**7.** Remeasure lactate if initial lactate is elevated [5].

maintain a mean arterial pressure (MAP) ≥65 mmHg.

**1.** Measure lactate level.

findings.

**Surviving Sepsis Campaign** has altered the approach to managing sepsis and septic shock, worldwide. It has helped to deliver early timely care to critically ill patients in as less than

Shock

33

http://dx.doi.org/10.5772/intechopen.76242

**5.** Apply vasopressors (for hypotension that does not respond to initial fluid resuscitation) to

**6.** In the event of persistent hypotension after initial fluid administration (MAP <65 mm Hg) or if initial lactate was ≥4 mmol/L, reassess volume status, tissue perfusion, and document

Thus, the early use of antibiotics is advised. Ensuring good oxygenation and ventilation, the use of fluids and vasopressors is the main pillar of treatment in septic shock [1].

The use of parenteral steroids is controversial and can only be considered in patients who are on chronic steroid therapy [1].

*Definitions and criteria for septic shock*:

Systemic inflammatory response syndrome (SIRS) includes (**Figure 4**):

Two or more of the following:


#### **Severe sepsis**:

**SIRS** with suspected infection associated with organ dysfunction [5].

**Figure 4.** Steps of sepsis [6].

#### **Septic shock**:

Hemostasis and balanced fluid therapy (including blood) should be started as soon as signs

As mentioned in the table above, patients in classes I and II have good compensatory mechanism to overcome the blood loss and may just need crystalloid infusion, while patients in classes III and IV have lost significant amount of blood and need to have blood transfusion [2].

Soft tissue injuries and fractures compromise the hemodynamics of patients with trauma, e.g.,

The cytokines released during tissue injury increase permeability of tissues. Fluid shifts and

It is the most common form of distributive shock. The body's defense system is overwhelmed by infection leading to life-threatening organ dysfunction. In resuscitating septic shock, few effects should be considered: hypovolemia, cardiovascular depression, and systemic inflammation. Besides, there is capillary leak, which causes intravascular volume loss. The combined interaction of chemical mediators, inflammation, and disturbed metabolism causes heart injury during septic shock. There is also capillary leak in the lungs, presenting as acute

Common causative organisms are pneumococcus, methicillin-resistant *Staphylococcus aureus*

Thus, the early use of antibiotics is advised. Ensuring good oxygenation and ventilation, the

The use of parenteral steroids is controversial and can only be considered in patients who are

use of fluids and vasopressors is the main pillar of treatment in septic shock [1].

Systemic inflammatory response syndrome (SIRS) includes (**Figure 4**):

• White blood cell count >12,000 or < 4000 or > 10% band neutrophilia [5].

**SIRS** with suspected infection associated with organ dysfunction [5].

• Respiratory rate > 20 breaths/min or paCO<sup>2</sup> < 32 mmHg.

volume depletion in the intravascular compartment cause hypovolemia [2].

of hemorrhage are suspected [2].

32 Essentials of Accident and Emergency Medicine

**6. Septic shock**

1500 ml blood can be lost in femur fractures [2].

respiratory distress syndrome (ARDS) [2].

on chronic steroid therapy [1].

Two or more of the following:

• Heart rate > 90 beats/min.

**Severe sepsis**:

• Temperature > 38°C or < 36°C.

*Definitions and criteria for septic shock*:

(MRSA), *Klebsiella pneumoniae*, *Pseudomonas aeruginosa*, etc. [4].

**SIRS** with suspected infection and hypotension, despite adequate fluid resuscitation [5].

**Surviving Sepsis Campaign** has altered the approach to managing sepsis and septic shock, worldwide. It has helped to deliver early timely care to critically ill patients in as less than 6 h [5].

The latest **Surviving Sepsis Campaign Bundles** are as follows:

To be completed 3 h of time of presentation:


To be completed within 6 h of time of presentation:


Document reassessment of volume status and tissue perfusion with either:

• Repeat focused exam (after initial fluid resuscitation) including vital signs, cardiopulmonary examination, and skin findings.

Or any two of the following:

