Description

epsis and Septic Shock Management Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, while septic shock is sepsis with persistent hypotension requiring vasopressors and a lactate >2 mmol/L despite adequate fluid resuscitation. 1. Immediate Management (First Hour – 'Golden Hour') A. Initial Resuscitation (Sepsis-6 Bundle) Oxygen – High-flow O₂ if hypoxic (target SpO₂ ≥94%). Blood cultures – Before antibiotics (but do not delay treatment). Broad-spectrum antibiotics – Within 1 hour of recognition (see below). IV fluid bolus – 30 mL/kg crystalloid (e.g., normal saline or balanced solutions like Ringer’s lactate). Lactate measurement – If >2 mmol/L, indicates tissue hypoperfusion. Vasopressors if refractory hypotension – Norepinephrine (1st-line) if MAP <65 mmHg after fluids. B. Hemodynamic Support Fluids: Crystalloids (avoid hydroxyethyl starch). Monitor for fluid overload (e.g., crackles, JVP↑). Vasopressors: 1st-line: Norepinephrine (α-agonist → vasoconstriction). 2nd-line: Vasopressin (if refractory shock). Epinephrine (if extremely unstable). Inotropes (if low cardiac output): Dobutamine (if poor ejection fraction). 3. Adjunctive Therapies A. Corticosteroids Hydrocortisone 50 mg IV q6h (if refractory shock despite fluids + vasopressors). Consider ACTH stimulation test (but do not delay steroids if shock is severe). B. Blood Glucose Control Target: 140–180 mg/dL (avoid severe hypoglycemia). C. Venous Thromboembolism (VTE) Prophylaxis LMWH (e.g., enoxaparin) or heparin SC. D. Stress Ulcer Prophylaxis PPI (e.g., pantoprazole) or H2 blocker (if high bleeding risk). 4. Monitoring & Supportive Care A. Hemodynamic Monitoring Arterial line (for continuous BP monitoring). Central venous catheter (for vasopressors, CVP monitoring). Echocardiography (assess cardiac function). B. Respiratory Support Mechanical ventilation if ARDS develops (use low tidal volume ~6 mL/kg). C. Renal Support CRRT (Continuous RRT) if AKI with fluid overload/refractory acidosis. 5. Prognostic Markers & Complications Poor prognosis: Lactate >4 mmol/L, persistent hypotension, multiorgan failure. Complications: ARDS, DIC, AKI, adrenal insufficiency, critical illness neuropathy.

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