Septic shock is a potentially lethal drop in blood pressure due to the presence of bacteria in the blood. This condition, characterized by the presence of bacteria in blood, is also called the bacteremia. It is proven that bacterial toxins together with the immune system which response to them, cause a dramatic drop in blood pressure, preventing the delivery of blood to the organs. What is the greatest danger of this shock? Well, experts are saying that the septic shock can lead to multiple organ failure including respiratory failure, and may cause rapid death. Possible causes and symptoms of septic shock
Before we skip to the probable cause of septic shock, we should first mention several details about the infection and bacterial toxins. The fact is that, during some infection, certain types of bacteria can produce and release complex molecules, called endotoxins. It is proven that these endotoxins may provoke a dramatic response by the body's immune system. The most important fact is that when, released in the bloodstream, these endotoxins are dangerous, because they become widely dispersed and affect the blood vessels themselves. It is normal that these arteries and the smaller arterioles open wider, but at the same time, the walls of the blood vessels become leaky, allowing fluid to seep out into the tissues, lowering the amount of fluid left in circulation. It is logical to assume where all this leads! Several researches done in the past have shown that this combination of increased system volume and decreased fluid causes a dramatic decrease in blood pressure and reduces the blood flow to the organs.
When does it commonly occur?
Well, although there are no rules, most experts claim that the septic shock is seen most often in patients with suppressed immune systems, and is usually due to bacteria acquired during treatment at the hospital. How come? Well, there are two reasons: first- the immune system is suppressed by drugs used to treat cancer, autoimmune disorders, organ transplants, and diseases of immune deficiency such as AIDS, and second- bacteria, found in hospitals, are much more resistant then the %26ldquo;usual%26rdquo; types found in other places! Some researches done on shock patients showed that this syndrome most often occurs in menstruating women using highly absorbent tampons. How come? Well, it is easy to explain %26ndash; these tampons, when left in place longer than other types; provide the perfect ground for Staphylococcus bacteria, which may then enter the bloodstream through small tears in the vaginal wall.
Statistical data
%26middot; Frequency:
Several researches done in the US have shown that more than 10 million patients who were diagnosed with sepsis. This accounted for 1.3% of all hospitalizations. The overall incidence of sepsis increased 3-fold over this period of time from 83 cases per year per 100,000 population to 240 cases per year per 100,000 population.
%26middot; Mortality/Morbidity
Although mortality from sepsis is extremely frequent, good thing is that these last couple of years-reduction in hospital mortality rates for sepsis from 28% to 18% is present! Some large studies have proven mortality rate of severe sepsis anywhere from 30-50%, whereas simply meeting SIRS criteria carries a mortality of less than 10%.
%26middot; Race
It is important to point out that the incidence of sepsis is higher in the non-white population, with the incidence in black men being the highest at 331 cases per year per 100,000 population.
%26middot; Sex
Most of the researches have confirmed that men are more likely to develop sepsis.
%26middot; Age
Experts are saying that men tend to develop sepsis earlier in life than women.
Risk factors for developing septic shock
Risk factors for septic shock include:
%26middot; Diseases of the genitourinary system, biliary system, or intestinal system
%26middot; Recent infection
%26middot; Long-term use of antibiotics
%26middot; Recent surgery or medical procedure.
%26middot; Diabetes
%26middot; Diseases that weaken the immune system such as AIDS
%26middot; Lymphoma
%26middot; Leukemia
Symptoms
Septic shock is secondary state, which means that it is usually proceeded by bacteremia, which is characterized by:
%26middot; Fever
%26middot; Malaise
%26middot; Chills
%26middot; Nausea
It is extremely important to point out that the first sign of shock is often confusion and decreased consciousness. In this beginning stage, the extremities are usually warm, but later, as the condition progresses, they become cool, pale, and bluish. Fever may give way to lower-than-normal temperatures later on in sepsis.
Other symptoms include:
%26middot; High or very low temperature, chills
%26middot; Lightheadedness
%26middot; Shortness of breath
%26middot; Palpitations
%26middot; Cool, pale extremities
%26middot; Restlessness, agitation, lethargy, or confusion
%26middot; Rapid heart rate
%26middot; Low blood pressure, especially when standing
%26middot; shallow, rapid breathing
%26middot; Decreased urination.
%26middot; reddish patches in the skin
Big problem is that this septic shock syndrome may progress to cause %26quot;adult respiratory distress syndrome,%26quot; ARDS which is extremely dangerous because the fluid collects in the lungs, and breathing becomes very shallow and labored. Experts are saying that this condition may lead to ventilatory collapse, in which the patient can no longer breathe adequately without assistance- a life threatening condition!
Diagnosis
How to recognize and diagnose the septic shock!? Like we have already mentioned in symptoms of the condition-the proper diagnosis of septic shock should be made by measuring blood pressure, heart rate, and respiration rate. Of course, parallel with all this should be searching for possible sources of infection. Most experts claim that the most precise diagnostic tool is simple blood cultures are done to determine the type of bacteria responsible for the bacteremia. If we look on the respiratory symptoms then we should know that the levels of oxygen, carbon dioxide, and acidity in the blood should also be monitored to assess changes in respiratory function.
Treatment
Like we have already mentioned, the severe sepsis is characterized by stimulation of a series of inflammatory cascades leading to extensive cardiovascular problems and the most obvious signs are hypotension due to vasoplegia, relative hypovolemia, and widespread dysfunction of the microvasculature. That%26rsquo;s why; the two major priorities in management of septic patients are
- To maintain delivery of oxygen to the tissues, by way of optimization of cardiac output and peripheral resistance, and
- To modulate the procoagulation response
Most experts say that septic shock should be treated initially with a combination of antibiotics and fluid replacement. Why? Well, it is logical to assume that the antibiotic is chosen based on the bacteria present, although two or more types of antibiotics may be used initially until the organism is identified and these fluids, which should be administrated intravenously, should replace the fluid lost by leakage. Coagulation and hemorrhage may be treated with transfusions of plasma or platelets.
Recommended antibiotics in septic shock | |
Suspected source | Recommended antibiotics |
Pneumonia | Second- or third-generation cephalosporin plus macrolide (antipseudomonal beta lactam plus aminoglycoside if hospital-acquired) |
Urinary tract | Ampicillin plus gentamicin (Garamycin) or third-generation cephalosporin |
Skin or soft tissue | Nafcillin sodium (Nafcil, Nallpen, Unipen) (add metronidazole [Flagyl, Metro IV, Protostat] or clindamycin if anaerobic infection suspected) |
Meningitis | Third-generation cephalosporin |
Intra-abdominal | Third-generation cephalosporin plus metronidazole or clindamycin |
Primary bacteremia | Ticarcillin and clavulanate potassium (Timentin) or piperacillin sodium and tazobactam sodium (Zosyn) |
Possible complications
Significant complications from sepsis include:
%26middot; central nervous system dysfunction
%26middot; adult respiratory distress syndrome (ARDS)
%26middot; liver failure
%26middot; acute renal failure (ARF
%26middot; disseminated intravascular coagulation (DIC)
Prognosis
Every patient should know that the chanced for recovery from septic shock depend on several factors and the most important including:
%26middot; the degree of immuno-suppression of the patient
%26middot; underlying disease
%26middot; promptness of treatment,
%26middot; Type of bacteria responsible.
Prevention
Like we have already mentioned- several researches done in the past have shown that septic shock is most likely to develop in the hospital, since it follows infections which are the primary form of this condition. That%26rsquo;s why; in order to prevent this it is crucial to know that careful monitoring and early, aggressive therapy can minimize the possible likelihood of progression. It is logical to assume that the risk of developing septic shock can be minimized through treatment of underlying bacterial infections, and prompt attention to signs of bacteremia.
Posts
