Septic shock
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| Septic shock |
Pathogenesis of shock/Causes of shock
What are the 3 stages of sepsis?
In general all forms of shock involve following 3 dearrangements:
Reduced effective circulating blood volume
Reduced supply of oxygen to the cells and tissues with resultant anoxia.
Inflammatory mediators and toxins released from shock induced cellular injury.
Pathogenesis of septic shock / septic shock causes
How do you get septic shock?
septic shock results most often from Gram Negative bacteria and trying the body from genitourinary tract elementary track respiratory tract for skin and less often from Gram positive bacteria in septic shock there is immune system activation and severe systemic inflammatory response to infections as follows :
1. Activation of macrophage-monocytes
Lysis of gram-negative bacteria releases endotoxin a lipopolysaccharide into circulation where it binds to Lipopolysaccharide binding protein(LBP).
The complex of LPS-LBP binds to CD14 molecule on the surface of monocyte macrophages which are stimulated to elaborate pro-inflammatory cytokines. The most important one being TNF- alpha and IL-1. The effect of these cytokines are as under
a. By altering endothelial cell adhesiveness : this results in recruitment of more neutrophils which liberate free radicals that cause vascular injury.
b. Promoting nitric oxide synthase : this stimulates increased synthesis of nitric oxide which is responsible for vasodilation and hypertension.
2. Activation of other inflammatory responses : microbial infection activates other inflammatory cascades which have profound effects in triggering septic shock. These are as under
Activation of complement pathway : end-products C5a and C3a induce micro emboli and endothelial damage.
Activation of mast cells : Histamine is released which increases capillary permeability.
Activation of coagulation system : enhances development of thrombi.
Activation of kinin system : Released bradykinin causes vasodilation and increased capillary permeability.
The net result of above mechanism is vasodilation and increased vascular permeability in septic shock profound peripheral vasodilation and pulling of blood causes hyperdynamic circulation in septic shock, in contrast to hypovolemic and cardiogenic shock increased vascular permeability causes development of inflammatory oedema. Disseminated intravascular coagulation(DIC) is proven to develop in septic shock due to endothelial cell injury by toxins. Reduced blood flow produces hypotension, inadequate perfusion of cells and tissues, finally leading to organ dysfunction.
septic shock treatment
Can septic shock be cured?
IV fluid injection
Supportive care with oxygen therapy
Treatment of low blood pressure or support
Antibiotics like peniclline for controlling bacterial growth.
septic shock symptoms
Low blood pressure
Shortness of breathing
Paleness
Low body temperature
Chills
Difficulty in breathing
Cooling of body under arms
