SEPTIC SHOCK

Course overview

SEPSIS SYNDROMES SPAN A CLINICAL CONTINUUM WITH VARIABLE PROGNOSIS. SEPTIC SHOCK, THE MOST SEVERE COMPLICATION OF SEPSIS, CARRIES A HIGH MORTALITY. SEPTIC SHOCK OCCURS IN RESPONSE TO AN INCITING AGENT, WHICH CAUSES BOTH PRO-INFLAMMATORY AND ANTI-INFLAMMATORY IMMUNE SYSTEM ACTIVATION. THIS OCCURS IN CONCERT WITH ACTIVATION OF MONOCYTES, MACROPHAGES, AND NEUTROPHILS THAT INTERACT WITH THE ENDOTHELIUM THROUGH PATHOGEN RECOGNITION RECEPTORS AND LEAD TO FURTHER INVOLVEMENT OF CYTOKINES, PROTEASES, KININS, REACTIVE OXYGEN SPECIES, AND NITRIC OXIDE. AS THE PRIMARY SITE OF THIS RESPONSE, THE ENDOTHELIUM NOT ONLY SUFFERS MICROVASCULAR INJURY BUT ALSO ACTIVATES THE COAGULATION AND COMPLEMENT CASCADES WHICH FURTHER EXACERBATE THE VASCULAR INJURY, LEADING TO CAPILLARY LEAKAGE. THIS CASCADE OF EVENTS IS RESPONSIBLE FOR THE CLINICAL SIGNS AND SYMPTOMS OF SEPSIS AND PROGRESSION FROM SEPSIS TO SEPTIC SHOCK. STRIKING A BALANCE BETWEEN PRO-INFLAMMATORY RESPONSES, WHICH HELP ERADICATE THE INVADING MICROORGANISM, AND ANTI-INFLAMMATORY SIGNALS, WHICH KEEP THE INFLAMMATORY CASCADE IN CHECK, ULTIMATELY DETERMINES THE DEGREE OF MORBIDITY AND/OR MORTALITY OF PATIENTS WITH SEPSIS. JUDICIOUS AND EARLY ANTIMICROBIAL ADMINISTRATION, SEPSIS CARE BUNDLE USE, AND EARLY GOAL-DIRECTED THERAPIES HAVE SIGNIFICANTLY AND POSITIVELY IMPACTED SEPSIS-RELATED MORTALITY. HOWEVER, EARLY IDENTIFICATION REMAINS THE BEST THERAPEUTIC TOOL FOR SEPSIS TREATMENT AND MANAGEMENT. THIS ACTIVITY DESCRIBES THE EVALUATION AND MANAGEMENT OF SEPTIC SHOCK AND HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN ENHANCING CARE DELIVERY FOR AFFECTED PATIENTS.