Curriculum · Toxicology and Emergency Care
Sepsis and septic shock resuscitation
What it is
The patient in septic shock is hypotensive, or has an elevated serum lactate, or both. Among the shock states it is the one with a high CO. Cardiogenic shock, hypovolemic shock, neurogenic shock and cardiac tamponade all sit on the low side of the same tree, and are separated further by HR, by PVR and by wedge pressure.
The goal of resuscitation is to restore perfusion, tissue oxygenation and hemodynamic stability. Early targeted therapy reduces mortality, which is why the fluid challenge is started as early as possible in the course of septic shock.
How it is diagnosed
Lactate does the work that blood pressure cannot. A serum lactate above 4 mmol/L is correlated with increased severity of illness and with poorer outcomes even if hypotension is not yet present, so a blood pressure that is still holding does not mean resuscitation can wait. A hypotensive patient and a patient whose serum lactate is raised are treated the same way.
A post-colectomy patient who is hypotensive with a lactate of 5 mmol/L is the worked example of septic shock.