COVID-19 Resources – Septic Shock Pathophysiology & Management
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COVID-19 has left us with many unanswered questions about the care and treatment for our pandemic population.
In response to the rising questions and concerns, I have decided to create some educational videos that we can refer back to related to the care and treatment of our COVID-19 patients.
Let’s get started on understanding how hemodynamics and arterial blood gas results effect our COVID-19 population.
Septic Shock Pathophysiology
When you hear the term sepsis or septic, the first thing that may come to mind is sewage such as a septic tank.
In a healthy individual, the blood is clean without infective material. In sepsis, an infection (sewage) or some other factor is causing inflammation in the bloodstream.
Sepsis = Infective material
Shock = Decreased tissue perfusion, decreased oxygenation of tissues, and low blood pressure
We begin by looking at a blood vessel.
Red blood cells within the vessel delivers oxygen to the tissues in exchange for carbon dioxide.
Infective material is introduced into the bloodstream
White Blood cells will encounter the infective material regardless if it is bacteria, viruses, or fungal infections. This infective material turns the blood vessels into septic pipes containing that sewage we discussed earlier.
The white blood cells’ job is to find the infective material and clean it up making the vessels sterile again. This process is called white blood cell activation.
This activation causes five things to occur
Step 1: call on other WBCs for help (WBC recruitment)
Step 2: Increase vessel diameter and vascular space
Step 3: WBC need to make the blood vessels leaky to get into the interstitial space
The increase in leakiness causes fluid build up in the tissues making it very difficult for oxygen to get to the tissues it needs to perfuse. This results in the cells becoming starved for oxygen.
Increase blood vessel diameter and increase leaky vessels are what primarily cause shock
Step 4: Increased damage to blood vessels
Coagulation factors (proteins that help cause clotting) are recruited due to the damage of blood vessels
When blood vessels get ruptured the body wanted to create clots to patch up the leaky spaces, so blood doesn’t continue to spill into the extravascular space
Important to remember: the leakage of blood vessels are happening everywhere!!
The coagulation factors that were deployed to help end up getting used up while trying to patch up the blood vessels. So clots start forming everywhere and some clots can break off into the bloodstream.
Step 5: Disseminated Intravascular Coagulation (DIC)
Septic Shock Complications
Acute Respiratory Distress Syndrome
Cardiac Output (amount of blood your heart pumps each minute)
Characteristics of Sepsis and Septic Shock
Septic Shock Recognition
Step 1: “Does the patient have 2 or more SIRS?”
Step 2: “Do you suspect an infection?”
SIRS + Infection = Sepsis
Stages of Septic Shock
Stages of Septic Shock – Initial
Multiple Organ Dysfunction in Septic Shock
Central Nervous System
- Decreased urine output
- Increased creatinine
- Decreased platelets
- Decreased Protein C
- Increased PT/PTT
3-Hour & 6-Hour Sepsis Bundles
Early detection – 1st 3 hours
Critical Care – 1st 6 hours