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Emergency Management of Severe Sepsis and Septic Shock

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Severe infections can lead to life-threatening conditions such as septic shock. Emergency medical treatment is essential for severe sepsis and septic shock.

Medically reviewed by

Dr. Basuki Nath Bhagat

Published At February 13, 2023
Reviewed AtMay 9, 2024

Introduction:

When a person has severe infections in the body, the infection can spread to the blood. This is a life-threatening complication of an infection and is called sepsis. The body reacts to the infection in the blood and releases certain chemicals into the blood to fight the infection. In severe cases, these chemicals in circulation (bloodstream) can cause inflammation and damage all body parts and vital organs. The vital organs such as kidneys, heart, lungs, and brain are also affected, and they malfunction, ultimately leading to shock and death. Therefore, it is essential to be aware of the signs and symptoms of septic shock to call for emergency help to prevent multi-organ failure and death.

What Is Septic Shock?

Shock is a serious medical condition that results from the sudden loss of oxygen-rich blood flow throughout the body. A marked drop in blood pressure is usually seen in shock. Without sufficient blood flow, the body cells and tissues do not get the required oxygen (hypoxia). When vital organs such as the brain and heart are deprived of oxygen, they stop functioning. This results in complications and emergencies such as cardiac arrests (the heart stops beating). If shock is caused due to a severe infection in the blood, it is considered a septic shock. Usually, sepsis is caused by certain bacterial infections that trigger an immune overreaction affecting the entire body. Sepsis causes tiny blood clots in vital organs and causes the blood vessels to widen, lowering blood pressure. Sepsis is considered severe when a multi-organ malfunction occurs due to an intense inflammatory response throughout the body. Septic shock is the most dangerous and severe form of sepsis. The low blood pressure and low oxygen supply to the organs seen in septic shock can be fatal without immediate medical attention.

Who Is at a Greater Risk for Septic Shock?

Patients with a weakened immune system have a greater risk of sepsis and septic shock. These include newborns, pregnant women, the elderly (over 65 years), and those with drug abuse and artificial joints or heart valves. In addition, chronic conditions such as acquired immunodeficiency syndrome (AIDS), cancer, diabetes, and other immune disorders have a higher risk of severe sepsis. Furthermore, patients who have had recent surgeries, transplants, infections, or medical devices implanted are at a higher risk for septic shock.

What Are the Warning Signs of Severe Sepsis and Septic Shock?

In sepsis, the patient develops weakness, fever, fast breathing, increased heart rate, and increased white blood cells in the blood. The symptoms depend on the location and type of the infection. For example, chest discomfort, cough, and breathing difficulty may be seen in respiratory infections such as pneumonia. Confusion, loss of alertness, warm and flushed skin, pounding pulse, and quick rapid breathing are seen in severe sepsis. The blood pressure falls severely, and urinary output is also reduced. As the infection worsens, the patient’s body temperature drops below normal (hypothermia), breathing becomes difficult, and the skin becomes pale and clammy. As the blood flow in the body further reduces, the skin may appear blue and vital organs begin to lose function (including the intestines, which can become necrosed and black due to loss of blood supply). In septic shock, the patients do not respond to treatment easily, and their blood pressure remains low, despite treatment initiation.

What Are the Health Complications Seen in Septic Shock?

Once the infection becomes severe and leads to septic shock, the patient develops small clots in the blood vessels of the vital organs and low blood pressure. The kidneys, heart, brain, lungs, intestines, and other parts of the body do not receive sufficient oxygen to function normally due to the decreased blood flow in the body as a result of low blood pressure. The heart rate and the quantity of blood pumped by the heart increase as the heart tries to compensate by overworking. The increased workload on the heart weakens it, which is worsened by the infection (bacterial toxins). Eventually, the heart cannot pump blood efficiently, further decreasing the blood supply to the body parts and organs. The tissues get damaged due to a lack of blood and oxygen, and they release excess waste products and acids (lactic acid). This leads to acidosis (the blood becomes acidic in nature), which further worsens the patient’s condition. It can lead to complications such as:

  1. Kidney failure (no urine is produced, and waste products begin to get retained in the blood).

  2. The blood vessel walls leak and allow fluid from the blood to enter the tissues leading to swelling.

  3. Heart failure.

  4. Lung failure (lung function worsens and severe breathing difficulty).

  5. Brain damage.

  6. Gangrene (the body tissues such as intestines die due to severe infection and lack of blood supply).

  7. Excessive bleeding may occur as the proteins that are necessary to form blood clots are already used up excessively by the microscopic blood clots in the blood vessels and organs (disseminated intravascular coagulation).

  8. Death.

When to Call for Emergency Medical Care in Severe Sepsis?

Immediately call for emergency medical help if one suspects severe sepsis or septic shock. The patient might have one or more of the following symptoms.

  1. Slurred speech.

  2. Confused.

  3. Utters words that do not make sense.

  4. Pale, blue, or blotchy skin, including the tongue and lips.

  5. Has trouble breathing.

  6. Does not breathe.

  7. Rapid breathing.

  8. Unconscious.

  9. Has a rash that does not fade when you roll a glass over it.

How Are Severe Sepsis and Septic Shock Managed?

Septic shock is usually diagnosed and managed in the emergency department and intensive care unit. The health care provider might conduct several tests to identify infection source, type, and severity. These include culture of blood, fluid, or tissue samples, blood tests, and imaging tests such as chest X-rays, computed tomography (CT), and magnetic resonance imaging (MRI). Blood tests are done to check the count of the various blood cells, blood chemistry, blood acid levels, blood oxygen, carbon dioxide levels, and indicators of organ malfunction. Septic shock is managed as an emergency, and antibiotics are given immediately. Fluids are administered through the vein to rehydrate the patient and increase blood pressure. Oxygen is delivered through a face mask or a small plastic tube inserted into the nostrils (nasal cannula). In addition, tubes to help with breathing may be inserted into the patient’s windpipe and connected to a machine that helps the patient to breathe (ventilator), if required. If abscesses are present, they are drained, and the infected and dead tissues are removed. Surgeries are performed whenever needed to remove the source of infection. In addition, the doctors may give medications to increase blood pressure if fluid resuscitation does not improve the blood pressure. Vasopressin and Nor-epinephrine are a few drugs that raise blood pressure by making the blood vessels narrower, and as a result, their administration can help the vital organs to get more blood. Septic shock can also markedly increase blood glucose levels, and insulin is given to such patients. Steroids may also be given if the patients respond poorly to medication and fluid resuscitation.

Conclusion:

Severe infections in the blood or sepsis can damage multiple vital organs and lead to shock (with low blood pressure). Such a life-threatening condition is known as septic shock. The low blood pressure and low oxygen supply to the organs seen in septic shock can be fatal without immediate medical attention. The symptoms depend on the location and type of the infection. In sepsis, the patient develops weakness, fever, fast breathing, increased heart rate, and increased white blood cells in the blood. Septic shock is usually diagnosed and managed in the emergency department and intensive care unit. Severe sepsis and septic shock lead to the failure of vital organs such as the brain, kidneys, heart, and lungs. If treatment is delayed, it can even be fatal. Thus, it is essential to recognize the symptoms of septic shock and seek emergency medical care.

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Dr. Basuki Nath Bhagat
Dr. Basuki Nath Bhagat

Family Physician

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