Shock Flashcards
Septic shock management: step 1
measure lactate level, remeasure if initial lactate level is elevated >2mmol/L
Septic shock management: step 2
obtain blood cultures before administrating ABX
Septic shock management: step 3
administer broad-spectrum ABX
Septic shock management: step 4
begin rapid administration of 30ml/kg IV crystalloids for hypotension or lactate >4mmol/L
Septic shock management: step 5
apply pressers if hypotensive during or after fluid resuscitation to maintain MAP ≥65mmHg
Giving ABX in sepsis: if it’s definite or probable
ABX immediately regardless of whether or not shock is present
Giving ABX in sepsis: if it’s POSSIBLE and shock is present
Give ABX immediately, within an hour
Giving ABX in sepsis: if it’s POSSIBLE and shock is absent
You get 3 hours to work the patient up and administer ABX if there’s a concern for infection
ABX selection: MRSA coverage
Prior Hx of MRSA infection/colonization
Recent IV ABX use
Hx of recurrent skin infections or chronic wounds
Presence of invasive devices
Hemodialysis
Recent hospital admissions
Severity of illness
ABX selection: MDR coverage
Proven infection of colonization with resistant organisms within the preceding year
Recent broad-spectrum IV ABX in the last 90 days
Travel to highly endemic country within the last 90 days
Local prevalence of ABX-resistant organisms
Hospital-acquired infections
Corticosteroids for septic shock
Hydrocortisone (+fludrocortisone)
When are corticosteroids added?
After poor response to fluids and pressors
Corticosteroid doses
Hydrocortisone 200mg IV QD x3-7 days
50mg IV q6h OR 200mg/day given as continuous infusion
Taper over 2-3 days when shock is resolved
Fludrocortisone 50mcg PO QD is sometimes added
Continue steroids until the patient comes off of vasopressors
