Septic Shock

1. SEPTIC SHOCK
NAVREET KAUR SAINI

2. OBJECTIVES
1. Sepsis and septic shock
2. Etiology of septic shock
3. Sign and symptoms of septic shock
4. Pathophysiology of septic shock
5. Diagnostic tests for septic shock
6. Medical and Nursing management of septic shock
7. Complications
8. Prognosis

3. SHOCK ??
A condition in which tissue perfusion is
inadequate to deliver oxygen and nutrients
to support vital organs and cellular function

4. SEPSIS ??
• Sepsis is a potentially dangerous or life-threatening medical
condition, found in association with a known or suspected
infection (usually caused by but not limited to bacteria)
• Sepsis happens when the body suffers from an infection and
the chemicals released into the blood to fight the infection
cause inflammation over the entire body.

5. SEPTIC SHOCK
•Septic shock is a serious condition that occurs when a body-
wide infection leads to dangerously low blood pressure,
multiorgan failure and death.
•Sepsis with hypotension (arterial BP <90mmhg or 40 mmhg
less than patient’s normal blood pressure) for atleast 1 hour
despite adequate fluid resuscitation.
•Need of vasopressors to maintain systolic blood pressure.

6. RISK FACTORS OF SEPTIC SHOCK
• Immunosuppression
• Extremes of age (<1 year and
>65 year)
• Malnourishment
• Chronic Illness
• Invasive procedures

7. PATHOPHYSIOLOGY
Infection
Microbial Toxins
Host defense system gets activated
Inflammatory Response
Adequate Excessive Inadequate
Survival Tissue Injury
Multiorgan failure
Death

8. SIGN AND SYMPTOMS
PHASE- I Hyperdynamic
•High cardiac output
•BP in normal limits
•Tachycardia, tachypnoea
•Fever, warm, flushed skin
•Normal or decreased urine output
•Nausea ,vomiting,diarrhoea
•Confusion /agitation

9. SIGN AND SYMPTOMS
Phase- II Hypodynamic (Irreversible)
•Low Cardiac output, Low BP
•Not responding to vasoactive agents
•Organ failure
•Cool and pale skin
•Increased H/R and R/R

10. INVESTIGATIONS
• Identifying cause of infection
• All invasive lines are sent for culture
• CBC, Electrolytes,RFT, LFT, ECG, CVP
• Clotting Profile
• Chest X-Ray
• Ultrasonography
• ABG

11. MEDICAL MANAGEMENT
• Volume resuscitation
• Early antibiotic administration
• Early goal directed therapy
• Rapid source identification and control.
• Support of major organ dysfunction.
• Need of Mechanical Ventilation

12. HEMODYNAMIC, RESPIRATORY AND METABOLIC
SUPPORT
• Primary Goal- Restore oxygen delivery to tissues and improve
cellular metabolism.
• Administration Of oxygen, IV fluids
• Administration Of Vasopressors- Norepinephrine, Dopamine
• Blood transfusions, FFP, Platelets
• Broad Spectrum Antibiotics
• Diuretics, Steroids

13. GENERAL MEASURES
• Nutritional Supplementation
• Prophylactic heparanization
• Preventing skin breakdown
• Preventing stress ulcers
• Maintaining normal blood glucose
levels

14. NURSING MANAGEMENT
• NURSING DIAGNOSIS
•Impaired cardiopulmonary tissue perfusion r/t widespread
infection
• Impaired fluid electrolyte imbalance r/t capillary leakage
s/t diseased condition
• Altered body temperature r/t widespread infection
• Risk of impaired skin integrity r/t diseased condition
• Risk of bleeding r/t diseased condition

15. NURSING INTERVENTIONS
1. To maintain cardiopulmonary tissue perfusion
• Assess vital signs every 2 hourly
• Administer oxygen as prescribed
• Assess skin for cyanosis, pallor
• Administer vasopressors as prescribed

16. 2. To maintain fluid electrolyte imbalance
• Assess sign and symptoms of fluid electrolyte
excess/deficiency
• Administer IV fluids, vasoactive agents as prescribed
• Administer enteral feed as far as possible
• Administer diuretics as prescribed
• Monitor urine output every hourly

17. 3. To prevent infection
• Assess vital signs every 2 hourly
• Assess initial signs of infection
• Meticulous hand washing
• Carry out all invasive procedures using aseptic
technique
• Administer antibiotics as prescribed

18. COMPLICATIONS
• Respiratory failure
• Cardiac Failure
• Any other organ failure
• Gangrene
• Death

19. PROGNOSIS
•Approx 40-60% of patients with septic shock die within
30 days
•Others die in mext 6 months as a result of
complications

20. SUMMARY
1. Sepsis and septic shock
2. Etiology of septic shock
3. Sign and symptoms of septic shock
4. Pathophysiology of septic shock
5. Diagnostic tests for septic shock
6. Medical and Nursing management of septic shock
7. Complications

21. CONCLUSION
 Meticulous handwashing, infection prevention
techniques, following aseptic precautions are the key to
prevent sepsis and septic shock.

22. REFERENCES
•Brunner & suddarth’s ,Text book of Medical Surgical
Nursing,11th edition,LWW pub,pg no 356-378
• Harrison’s, Textbook of principles internal medicine, 17th
Edition, Chapter 265- Sepsis and septic shock
•Tintinalli’s ,Text book of Emergency Medicine,6th edition,HTML
file
•http://www.pubmedcentral.nih.gov
•Joyce M Black ,Medical Surgical Nursing,7th edition,saunders
publication,pg no 2433 -2476

24. QUESTIONS??
What is septic shock?
What are risk factors of septic shock?
What are clinical manifestation of septic shock?