Septic Shock Essay Example | Topics and Well Written Essays - 2500 words

Septic Shock - Essay Example The patient’s skin appears warm, dry and flushed. I called the resident-on-call to report these deviations in the vital signs, and he ordered 2 intravenous boluses of NSS (normal saline solution) 500cc and oxygen administration of 2 liters per minute via nasal prongs (NP). There is no order for serum lactate measurement or arterial blood gas analysis. There are also no orders for blood culture, blood chemistry, or even antibiotics. Four hours after surgical ICU admission, my patient was still in high fever, having a systolic BP of 75 mmHg, HR of 145 per minute, RR of more than 40 breaths per minute, low oxygen saturation, decreased LOC (level of consciousness) and decreased urine output (see table 1 for summary of the trend). I called the resident-on-call again, but there was no response. I called the RRT (rapid response team) instead. See the following Table for the trend: Vital Signs 2 hours later 4 hours later BP 75/40 mmHg 75 mmHg systolic HR 130 per minute 145 per minute RR 30 per minute 40 per minute Oxygen Saturation 88% It would appear that this was not recognized appropriately as management of the patient did not improve the cardiovascular status. Within the four-hour span of surgical ICU admission, most assessment, diagnostic procedures, medical and evaluation necessary for septic shock management were absent, and there was only two hours remaining for the 6-hour crucial period of the Sepsis Resuscitation Bundle. Case Outline In a normal physiology, the three components of blood circulation compensate each other to maintain the normal circulation, which are the heart, the vascular tone and the blood volume in maintaining adequate systemic perfusion. For example, if there is inadequate circulating blood volume, the baroreceptors of the aortic arch will signal the heart to increase the heart rate to raise blood pressure. Other organs in the circulation, like the kidneys, will compensate as well, like the activation of rennin-angiotensin-aldostero ne system, which will also increase the vascular tone and stimulate fluid retention. When these compensatory mechanisms fail to maintain an effective systemic perfusion, shock occurs as a result (Black & Hawks, 2005). The inadequacy of systemic perfusion in septic shock is only an aftermath of the systemic effects of microorganisms present in the body, whether it is in the bloodstream (septicemia) or localized infection. A number of risk factors are associated with septic shock: age, co-existing infection, co-existing hepatic, renal and heart failure, decreased white blood cells, unknown source of infection, corticosteroid use, and retention of foreign body in the system (Leibovici et al, 1997; Labelle et al, 2008; Annane et al, 2003; Brun-Buisson et al, 1995). It is uncertain whether infection occurred from the patient’s previous abdominal surgery or otherwise. Black and Hawks (2005) gives an excellent pathophysiology of septic shock. The invading pathogen releases endotoxin s which generates a myriad of reactions in the body. One is the activation of kinins, specifically bradykinin, which is the main responsible for the hypovolemic state in septic shock since it causes vasodilation, decreasing blood pressure and venous return. When the offending microorganism is destroyed, tumor