Management of Septic Shock

     There are several predispositions for the occurrence of this complex disease.  Some of them include chronic illness in elderly clients, antibiotic resistance, and chemotherapy. 

     Immunosuppressive drugs pose a risk as well.  So does the presence of diabetes mellitus.  Other factors which create risk are leukemia, recent infection, and lymphoma.  This serious condition can increase the possibility anywhere in the human body.  In fact, there may be low blood pressure, dysfunction of organs, and failure of the tissue to perfuse through the body.  Suspicion on the part of the physician that any of these are present is enough to mandate initiation of antimicrobial therapy (1, 2, 3).

     The utilization of fluid therapy is important early in the detection of septic shock.  Clinicians must also keep in mind that occurrence of fungal infection today is higher than it has been in the past.  Naturally, this leads to more cases of sepsis from fungal infection than have been present in the past.  In any event, the clinician must reverse organ dysfunction and furnish enough oxygen to the human body (1, 2, 3).

     The application of intravenous crystalloid is controversial.  On one hand, it serves to replenish fluid loss and restore normal blood pressure.  Should one decide to use this method, he or she must do so within three hours of the onset of this illness.  At the same time, excessive administration of fluid therapy may lead to acute pulmonary edema, respiratory failure, or intra-abdominal hypertension.  Physicians know that such a bolus is the gold standard for these seriously ill clients.  However, they also realize that excessive administration of that can lead to overload (1, 2, 3).

     Despite the controversy over these matters, there is a very good method to evaluate fluid responsiveness.  That is the passive leg-raise test (1).  Another important assessment of the patient’s blood pressure is with mean arterial pressure.  Moreover, some of these clients require vasopressors.  These include drugs such as norepinephrine which is a first-line agent.  Second-line medications include vasopressin or epinephrine.  Of course, epinephrine has been well-known to physicians for decades, and one must remember that it may lead to rapid heart rate, rhythm disturbances of the heart, and lactic acidosis (1).

     It is also possible to improve the patient’s condition with blood lactate levels.  In fact, such an approach can lower mortality rates.  In general, there are several ways to address these clients, and the doctor must decide which method is best for the case (1, 2, 3).

     The evaluation and management of septic shock are obviously complex.  There may be skin rash, alteration of mental status, agitation, and significant variations in body temperature.  As with most diseases, there must be laboratory evaluation such as serum chemistries, complete blood count, and urinalysis.  As microorganisms may be present, it is wise to perform a chest radiograph, blood cultures, and electrocardiogram.  Without question, these patients must be in hospital intensive care until enough improvement takes place (1, 2, 3).

     There may be a need for these patients to have mechanical ventilation, renal dialysis, sedatives, oxygen, and antimicrobial therapy.  Medications are also available to manage clotting of the blood, infection, and low blood pressure.  Surgical drainage is reasonable for regions of the body which stem from infection.  Unfortunately, some patients undergo amputation because of gangrene          (1, 2, 3).

     Sepsis has appeared in the literature for decades.  Despite progress that  healthcare professionals have made, it is still a challenge.  Such management requires highly-skilled staff. 

1. Dugar, S., Choudhary, C., and Duggal, A.  (2020).  Sepsis and septic shock:  Guideline-based management.  Cleveland Clinic Journal of Medicine, 87, 53-64.
2. U.S. National Library of Medicine.  National Institutes of Health.  (2017).  Septic shock. 
3. U.S. Centers for Disease Control.  (2019).  Sepsis.    
4. Copyright 2020.  Michael Koger, Sr., M.D.  All rights reserved.

     The information contained in this article is for educational purposes only, and one should not use it for diagnosis or treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.