Septic Shock - Shock States

Question 1

In septic shock all patients should receive a 30 mL/kg bolus of crystalloid if hypotensive and/or a lactate of what?

Answer 1

If hypotensive (<90 mmHg / MAP <65 / drop of 40 mmHg from baseline) and/or a lactate of >4 mmol/L

Question 2

What’s the preferred crystalloid for septic shock?

Answer 2

Ringers lactate (less likely to cause hyperchloremic metabolic acidosis)

Question 3

In a septic shock patient with profound hypotension (MAP <50) or pre-arrest you should patch for push-dose epi and start a Norepinephrine infusion at a minimum of what?

Answer 3

Min. 0.3 mcg/kg/min

Crystalloid bolus should be given concurrently

Question 4

In septic shock you should consider Calcium Chloride (1 g over 1 hr) if the calcium levels are lower than what?

Answer 4

Ionized Ca <1

Ca <2.0

Question 5

In septic shock if the hypotension is refractory to 30 mL/kg NS AND norepinephrine you should patch for what 3 medications?

Answer 5

Vasopressin
Epi infusion
Hydrocortisone