Septic Shock

Septic shock: A→ LOC, full stomach B→ resp failure, ARDS, pul edema C→ low or high output failure, ↓SVR, D→ Abx, APC, steroids, inotrops, vasopressors Met→ lactic acidosis, base deficit, ↑K, lytes disturbance, adrenal insufficiency Renal→ ATN, ARF Heme→ thrombocytopenia, DIC Management: • ABC • ECG, Sat, Art-line, CVP/PAC, frequent ABG, • Lab: CXR, ABG, ECG, CBC-D, Blood C/S, sputum, and urine, lytes, BUN, creat, LFT, PT, PTT, Fibrinogen, D-dimer, ACTH stim test, if suspecting a source of infection do further investigation e.g. TEE or TTE for ? edocarditis, abdominal → CT….. • Early goal directed therapy( CVP 8-12, MAP >65, Urine>0.5ml/kg/hr, SvO2>70%) • Broad spectrum ABx

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Fluid therapy 1-2L of crystalloids Start vasopressors and inotrops Steroids for Pt become unresponsive to inotrops after doing the ACTH test, but do not wait for the result the dose 200-300mg/d hydrocortisone Blood to target Hb 7-9g/dl Consider giving APC if there is no contraindication which is mainly bleeding, post-op Pt Mech vent manage as ARDS → AC volume control Vent, Vt 6ml/kg, keep the plateau pressure <30cmH2O, PEEP ↑ with ↑ FiO2 Tight Glucose control 4-7 mmol/l→ insulin DVT prophylaxis sq heparin 5,000, or pneumatic stocking if heparin is C/I ARF → consider Prisma Stress ulcer prophylaxis Zantac 50mg, IV BID APACHE score