- Main symptoms
- Possible causes of septic shock
- How to confirm the diagnosis
- How the treatment is done
- 1. Use of antibiotics
- 2. Hydration in the vein
- 3. Blood pressure medications
- 4. Blood transfusion
- 5. Use of corticosteroids
- 6. Hemodialysis
Septic shock is defined as a serious complication of sepsis, in which even with the proper treatment with fluid and antibiotic replacement, the person continues to have low blood pressure and lactate levels above 2 mmol / L. These parameters are regularly evaluated in the hospital to check the patient's evolution, response to treatment and the need to perform other procedures.
Septic shock is considered a challenge, because when the patient reaches this stage of the disease, he is already more debilitated, besides that there is a greater infectious focus and a greater predominance of toxic substances produced by microorganisms.
Due to the decrease in blood pressure, it is common for people in septic shock to also have greater difficulty in blood circulation, which causes less oxygen to reach important organs such as the brain, heart and kidneys. This causes other, more specific signs and symptoms of septic shock to appear, such as decreased urine output and changes in mental status.
The treatment of septic shock is done in the Intensive Care Unit (ICU), using medications and antibiotics to regulate cardiac and renal functions and eliminate the microorganism that causes the infection, in addition to monitoring the pressure and lactate levels.
Main symptoms
As septic shock is considered a complication of sepsis, the signs and symptoms presented by the patient are the same, with high and persistent fever and an increase in heart rate. In addition, in case of septic shock it is also possible to observe:
- Very low blood pressure, with mean arterial pressure (MAP) less than or equal to 65 mmHg; Increase in circulating lactate concentration, with concentrations above 2.0 mmol / L; Fast breathing in an attempt to increase the amount of circulating oxygen; Less urine production; Loss of consciousness or mental confusion;
The symptoms of septic shock arise when the microorganism reaches the bloodstream and releases its toxins, which stimulate the immune system to produce and release cytokines and inflammatory mediators to fight this infection. If the patient does not respond to treatment or the toxicity of the microorganisms is very high, it is possible that the patient will develop into severe sepsis and then septic shock.
Due to the large amount of toxins, there may be changes in the amount of oxygen that reaches the organs, which can result in organ failure and putting the person's life at risk.
Possible causes of septic shock
The occurrence of septic shock is related to the resistance of microorganisms to treatment, in addition to the person's immune system. People who have been in hospital for a longer time, who have diseases that compromise immunity, who have had surgery recently, who are malnourished or who are older, are at greater risk of developing septic shock.
Other possible causes of septic shock are the presence of infected probes and catheters, as they are hospital equipment that is in direct and daily contact with the hospitalized patient. Thus, the microorganism can spread more easily into the bloodstream, proliferate and release toxins that end up compromising the functioning of the organism and the supply of oxygen to the tissues, characterizing septic shock. Learn more about the causes of septic shock.
How to confirm the diagnosis
The diagnosis of septic shock is made based on the person's clinical examination and laboratory tests. Normally a blood test is done in which it is identified if the blood cell count is altered (red blood cells, leukocytes and platelets), if there is a problem with kidney function, what is the concentration of oxygen in the blood and if there is any change in the amount of electrolytes present in the blood. The other tests that the doctor may order are related to the identification of the microorganism that causes the shock.
The diagnosis is conclusive for septic shock when, in addition to the characteristic signs and symptoms of sepsis, an increase in lactate concentration and persistence of low blood pressure is identified even after treatment.
How the treatment is done
The treatment of septic shock must be done in the ICU (Intensive Care Unit) and aims to eliminate the causative agent of sepsis and, in this way, to resolve septic shock. In addition, the use of vasoactive drugs to regulate blood pressure is indicated, in addition to fluid replacement to increase the amount of blood and, consequently, favor the transport of oxygen to the tissues.
1. Use of antibiotics
If septic shock is confirmed, a potent antibiotic should be started, even if the focus of the infection is not yet known. This is so that the microorganism that causes the infection is eliminated as soon as possible, decreasing the body's immune response.
Treatment is done with the use of antimicrobials (antibiotics) according to the identified microorganism. Learn more about the test that helps you identify the best antibiotic.
2. Hydration in the vein
In septic shock, blood circulation is extremely impaired, which makes oxygenation of the body difficult. High doses of serum in the vein, about 30 ml per kg, are recommended as a way to help maintain acceptable blood flow and improve response to medications.
3. Blood pressure medications
Due to the drop in blood pressure, which is not resolved only with hydration in the vein, it is usually necessary to use drugs to raise blood pressure, called vasopressors to achieve an average blood pressure of at least 65 mmHg.
Some examples of these drugs are Noradrenaline, Vasopressin, Dopamine and Adrenaline, which are drugs that must be used with close clinical monitoring to avoid further complications. Another option is to use drugs that increase the heartbeat strength, such as Dobutamine.
4. Blood transfusion
It may be necessary for patients who have signs of insufficient blood flow and who have anemia with hemoglobin below 7mg / dl. Check the main indications of blood transfusion.
5. Use of corticosteroids
Corticosteroid medications, such as Hydrocortisone, can be indicated as a way to reduce inflammation, however, there are only benefits in case of refractory septic shock, that is, in cases where blood pressure cannot be improved even with hydration and use of medicines.
6. Hemodialysis
Hemodialysis is not always indicated, however, it can be a solution in severe cases in which rapid removal of excess electrolytes, acidity in the blood or when the kidneys are not functioning properly.
