Septic Shock Management Step Three - -Antibiotics (first 60 min)
-Broad Spectrum antibiotics
-Try to obtain culture first
-Consider IM administration if
hard to get IV access
- Start with Gram Negative spectrum before Gram Positive
Septic Shock Management Step One - - Recognition and Access: ...
- Start with Gram Negative spectrum before Gram Positive
Septic Shock Management Step One - - Recognition and Access: Diminished LOC, begin HFNC, if
hypoxic intubate
- Start IV access: peripheral or central
What does SIRS stand for? - Systemic Inflammatory Response Syndrome
Key characteristics of Endotheliopathy - • Capillary leak
• Vasomotor paralysis tone of vessels not normal
• Leukocyte infiltrations
• Coagulopathy
• Myocardial depression
• Immune-compromise
Patient Qualifications of SIRS based off clinical findings. - Two Abnormalities
-Must be abnormalities of temperature (greater than 38 rectal or less than 36 rectal) or WBC in children
-Other abnormalities include:
1. HR (Tachycardia)
2. RR (Tachypnea)
3. PaCo2 Less than 32
4. Abnormal WBC>12,000 or less than 4,000
, 5. WBC bands greater than 10% differential
Management of SIRS - 1. Treat underlying Cause
2.Manage coagulopathies: thrombocytopenia← replace platelet, clot formation← give thrombolytic,
bleeding
3. Mange the endothelipathies: stop inciting insult, fluid resuscitate, increase plasma oncotic pressure
(colloid administration)
4. Promote Vasoconstriction: Alpha Agonist
Septic Shock - - Sepsis plus CV dysfunction: Abnormal perfusion as well as hypotension.
- Children able to maintain BP longer than Adults
Septic Shock Management Step Two - - Fluid Resuscitation
- Rapid administration 20mL/Kg bolus of isotonic crystalloid
-Run over 5-10 minutes
• 0.9% NaCL (normal saline)
• Lactated ringers
Septic Shock Management Step Four - 4. Inotropic Agent support
WARM SHOCK - 1. High cardiac output
2. Low Systemic Vascular Resistance (SVR)
Inotropic Agent for Warm Shock? - 1. Dopamine
2. Nor-epi
*Utilize EPI or Vasopressin if not responsive
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