Bonus Material-23_Shock Sepsis_Quill_2025

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This presentation by Dr. Caroline M Quill covers shock, sepsis, and hemodynamic monitoring, emphasizing diagnosis, management, and outcomes in critical care.

<strong>Shock</strong> is characterized by cellular hypoxia leading to organ damage and potentially death, initially reversible. Diagnosis hinges on systemic hypotension, hypoperfusion, and elevated lactate, though absence of lactate elevation does not exclude shock. Shock has four main types: distributive (vasodilatory), cardiogenic, obstructive, and hypovolemic. Point-of-care ultrasound (PoCUS) is a valuable tool for assessment and guiding therapy.

<strong>Hemodynamic monitoring</strong> includes arterial pressure, central venous pressure (CVP), pulmonary artery catheterization (PAC), and cardiac output measurements. PAC allows measurement of right atrial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP), cardiac output, and derived indices like systemic vascular resistance. Normal values inform shock assessment and treatment.

<strong>Shock management</strong> depends on the underlying cause, focusing on fluid resuscitation and vasopressors. Fluid therapy targets stroke volume and oxygen delivery but over-resuscitation can worsen outcomes. Dynamic tests like passive leg raise and pulse pressure variation help guide fluid responsiveness. Norepinephrine is the first-line vasopressor; dopamine should be avoided due to harm evidence. Pressor choice varies by shock type.

<strong>Sepsis</strong> is defined as life-threatening organ dysfunction caused by dysregulated host response to infection. Septic shock involves persistent hypotension post fluid resuscitation with elevated lactate. Diagnosis uses SOFA score changes with specific organ criteria. Early recognition with NEWS or MEWS scores is recommended over qSOFA. Management includes prompt antibiotics (within 1 hour), fluid resuscitation (30ml/kg crystalloid), vasopressors to target MAP ≥65 mmHg, and source control within 12 hours.

Balanced crystalloids are preferred; hydroxyethyl starch is contraindicated. Vasopressors begin with norepinephrine; vasopressin or epinephrine may be added. Dobutamine may support myocardial dysfunction but targeting supranormal cardiac output levels is discouraged. Stress-dose steroids may benefit select septic shock patients. Transfusion targets favor hemoglobin ≥7g/dL.

Antibiotic de-escalation based on clinical reassessment is essential. Routine use of CVP, ScvO2, or pulmonary artery catheters is not recommended except in specific scenarios.

Post-sepsis survivors benefit from follow-up for physical, cognitive, and emotional sequelae.

Meta Tag

Concept Shock

Concept Septic Shock

Concept Sepsis

Concept Organ Failure

Concept Hemodynamic Monitoring

Keywords

shock

sepsis

hemodynamic monitoring

vasopressors

norepinephrine

fluid resuscitation

point-of-care ultrasound

pulmonary artery catheter

septic shock

critical care

Shock

Septic Shock

Sepsis

Organ Failure

Hemodynamic Monitoring