Shock, Septic, Severe Sepsis and Septic Shock

Shock is a clinical syndrome that occurs as a result of hemodynamic and metabolic disorder characterized by failure of the circulatory system to maintain adequate perfusion to vital organs of the body. This hypoperfusion causes an imbalance between the needs and the delivery of oxygen, resulting in cellular dysfunction.

Septic is a systemic response of the host to infection causing activation of the inflammatory process. Sepsis diagnosis is established if there are at least two of the symptoms of SIRS (Systemic Inflammation Response Syndrome), namely:

1. Fever (oral temperature is over 38 ° C) or hypothermia (less than 36 ° C);
2. Tachypnea (RR more than 24x / min);
3. Tachycardia (pulse more than 90x / min);
4. Leukocytosis (Leukocyte more than 12,000 / microliter) or Leukopenia (less than 4000 leukocytes / microliter), or more than 10% Bands, accompanied by an infection that can be estimated or proven.

Told as severe sepsis when there is sepsis accompanied with hypotension or hypoperfusion, which leads to one or more of the signs of organ dysfunction, for example:

1. Cardiovascular: systolic BP less than 90 mmHg or MAP less than 70 mmHg are responsive to fluid therapy.
2. Renal: Urine output is less than 0.5 ml / kg / hr for 1 hour with adequate fluid therapy.
3. Respiratory: PaO 2 / FiO 2 ratio less than 250.
4. Haematological: platelet count less than 80,000 / MCL or decrease of more than 50% of the highest value the previous 3 days.
5. Metabolic acidosis that can not be explained, the pH is less than 7.3 or base deficit of more than 5mEq / l and plasma lactate levels more than 1.5x the normal value of the highest laboratory.
6. At adequate fluid resuscitation, PAWP more than 12mmHg or CVP more than 8mmHg.

If sepsis with hypotension that persists for more than 1 hour with adequate fluid resuscitation or requiring vasopressors to maintain a systolic BP of more than 90mmHg, then known as septic shock.

Cold shock occurred in the final phase of septic shock. Two main symptom is subnormal temperature and leukopenia. Hypotension and hypoperfusion intensified. The skin becomes cold and raised blotches wider. Pulse and rapid breathing due to sympathetic stimulation and increase in levels of catecholamines. CO decreases, vasoconstriction occurs selectively in circulation kidneys, lungs, and splanchnic. Multisystem failure causes: pulmonary edema, ARDS, liver failure, and heart, and DIC. Decreased consciousness along with a decrease in cerebral perfusion.