PATHOPHYSIOLOGY OF SEPTIC SHOCK
Predisposing & Precipitating
> Extremes of age (70 years) > Major surgery, trauma, burns
> Primary diseases (e.g., liver cirrhosis, diabetes mellitus, > Invasive procedures (e.g., placement of catheters,
cardiopulmonary diseases, late stage cancer, intravascular devices, prosthetic devices, hemodialysis
Risk Factors
acquired immunodeficiency syndrome) and peritoneal dialysis catheters, or endotracheal tubes)
> Immunosuppression (e.g., from > Common illnesses and other infections (e.g., lung
EARLY, REVERSIBLE AND COMPENSATORY SHOCK
neutropenia, immunosuppressive therapy [e.g., in organ and bone infections like pneumonia, gastrointestinal infection,
marrow transplant recipients], corticosteroid therapy, injection or urinary tract infections, nosocomial infections, etc.)
IV drug use, complement deficiencies, asplenia)
> Prolonged hospitalization
> Weak immune systems
> Other factors (e.g., childbirth, abortion, and malnutrition)
> Underlying genetic susceptibility
SEPTICEMIA
caused by caused by
GRAM-NEGATIVE GRAM-POSITIVE
ORGANISMS ORGANISMS
FIRST STAGE
Sources of Infection
Release Release
Etiology
Endotoxins TRIGGERS Exotoxins
example example
Lipopolysaccharide complex Superantigens (Type I toxins);
associated with the outer Response mechanisms occur Exotoxins that damage host cell membranes
(Type II toxins); and.
membrane of Gram-negative
pathogens
during septic shock, but on a systemic scale A-B toxins and other toxin that interfere with
host cell function (Type III toxins)
Release of inflammatory chemical mediators
Pro-inflammatory Response
Activation of immunological system
INTERMEDIATE OR PROGRESSIVE SHOCK
CELL-DERIVED PLASMA PROTEIN
LYMPHOCYTES GRANULOCYTES MONOCYTES
MEDIATORS SYSTEMS
SECOND STAGE
Anti-inflammatory Response
References:
References:
LeMone, P. (2017). Medical-surgical nursing:
Sorenson, M., Quinn, L., & Klein, D. (2019). Critical
Pathophysiology: Concepts of human disease. thinking for person-centred care. Melbourne, VIC:
NY, NY: Pearson. Positive Feedback Mechanism
Result to
Pearson Australia.
Andre Kalil, M. (2020, October 07). Septic McCance, K. L., Huether, S. E., Brashers, V. L.,
Shock. Retrieved October 28, 2020, from
https://emedicine.medscape.com/article/168402- & Rote, N. S. (2019). Pathophysiology: The
ENDOTHELIAL DYSFUNCTION biologic basis for disease
overview
in adults and children. St. Louis: Elsevier
Manifestations
Capillary Leak Microvascular Trombus Cell Adhesion Tissue Hypoxia Apoptosis Impaired Vascular Tone Free Radical Damage
Clinical
REFRACTORY OR IRREVERSIBLE SHOCK
SEPTIC
MULTIPLE ORGAN DYSFUNCTION
SHOCK
THIRD STAGE
Signs and Symptom
Altered Mental p/f ratio <300 Urine Hypotension Thrombocytopenia Metabolic Acidosis
Lab Test result
Poor Capillary Refill
Status Tachypnea <0.5 ml/kg/hr Tachycardia High 0-dimer High Lactate
DEATH
