Septic shock

Septic shock It is a medical situation in which the organs and tissues of the body do not receive a sufficient supply of oxygen and nutrients, which leads to a progressive death of cells and a failure in the function of the different organs that can lead to death.

This lack of supply is produced basically because the amount of blood that reaches the tissues is insufficient due to a malfunction of the heart (cardiogenic shock), a loss of body fluids (hypovolemic shock) or a serious infection (septic shock ). Thus, septic shock is a type of shock that occurs as a result of a generalized inflammatory response of the body due to an infection.

How is it produced?

Usually when a microbial infection of the body occurs the immune system he is capable of controlling it and keeping it localized. However, in some cases, the defenses cannot fight the infection effectively and / or the microorganisms eliminate toxins, a series of mechanisms are set in motion that cause generalized inflammation, producing a septic shock.

These mechanisms, which are complex, produce an alteration in different organs such as the liver, kidney and lung and alter the functioning of blood clotting and the cardiovascular system. It is more common for septic shock to appear in patients with altered immune systems such as infants, the elderly, or people with immunosuppression (such as the chronically ill).

Bacteria are the main microorganisms that cause septic shock;it can also be due to fungal infections. The initial infection from which a generalized reaction occurs can be localized at the respiratory-pulmonary, genito-urinary, abdominal, skin and tissue or gynecological level, among others.

Symptoms

The development of a generalized infection gives rise to a series of alterations of the organism that are reflected in symptoms such as:

• Fast breathing.
• Palpitations due to increased heart rate.
• Confusion and dizziness due to altered level of consciousness.
• Changes in temperature and color of the skin.
• Fever.
• Generalized weakness and malaise due to low blood pressure.
• Decreased diuresis.

Diagnosis

The diagnosis is based on the medical history and the signs that the patient presents and that include:

• High heart rate: tachycardia.
• High respiratory rate: tachypnea.
• Arterial hypotension
• Oliguria: decrease in the volume of urine emitted.
• Fever.

The physical examination allows to detect these alterations and the medical history to determine the possible causes of shock.

Other useful follow-up scans that need to be performed for diagnosis include:

• Analytics (hemogram and biochemistry) that allows to determine the existence of infection and if there is involvement of other organs such as the kidney, liver or coagulation due to infection.
• blood clotting tests, in septic shock they may be altered.
• It will show the degree of oxygenation of the blood and the lack of oxygenation of the tissues.
• Microbiological cultures. Samples of blood (blood culture), urine (urine culture), respiratory secretions or those foci suspected as the source of the infection are obtained to detect the responsible bacteria and give a specific antibiotic.
• Imaging tests such as ultrasound, CT (computerized) and to identify the focus of infection: collection of pus in the abdomen, pneumonia, kidney infection (pyelonephritis), etc.

Treatment of septic shock

Early treatment is essential to improve the prognosis and resolution of septic shock. It is a disease that requires urgent hospital care. Treatment is based on the introduction of antibiotics, fluid intake and drugs to maintain blood pressure.

• Volume replacement by administration of fluids through a vein. Liquid solutions such as crystalloids or colloids can be administered.
• Sometimes the fluid intake is not enough to maintain adequate blood pressure that allows blood to reach the tissues and it is also necessary the use of other drugs intravenously. The most used are dopamine and norepinephrine.
• Treatment antimicrobialantibiotics or antifungals are given to fight the infection.
• Specific treatment of the cause, such as drainage of a collection of pus.
• Treatments for complications of shock: blood clotting disorders, kidney failure that may require dialysis or lung that requires the patient to need a device (ventilator) to breathe.

Other so-called support measures are aimed at maintain the patient's vital signs and control the evolution of shock:

• Administration of oxygen.
• Control of constants: blood pressure, heart rate, respiratory rate and oxygen saturation. For this, specific devices called monitors are used.
• Control of diuresis. One of the indicators that the patient is recovering and the fluid intake is adequate is the recovery of urine output. It requires the placement of a urinary catheter.

Precautionary measures

It must be taken into account that it is a medical situation that sets in quickly and that it can have very serious consequences, therefore, it is always a medical emergency that requires urgent attention. Correct antibiotic treatment of an initial infection can prevent the development of septic shock.

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