Septic shock: Diagnosis and treatment | Circulatory System and Disease | NCLEX-RN | Khan Academy

Septic shock: Diagnosis and treatment | Circulatory System and Disease | NCLEX-RN | Khan Academy


– [Voiceover] To understand
the labs of septic shock, let’s first go ahead and
recall what septic shock is. So really briefly,
remember, septic shock is an infective material that
you see in blood vessels. White blood cells amount a
response to the septic material. In amounting a response, they
release all these different immune molecules that can
cause damage to blood vessels and increase blood vessel
diameter, and the permeability of blood vessels, and so on and so forth. What’s the first thing you think you would want to do in a patient
who might have shock? Well first of all, we want
to diagnose it, right? So what can we do to diagnose shock? Well we have a couple of
lab tests that we can use. The first thing you want to
do is check what’s going on. A patient comes in who has fevers, chills, they’re sweating, they’re very flushed. You notice that their
blood pressure is dropping. So you’re thinking, maybe septic shock. So the first thing you
want to do is, aside from checking their temperature and checking their vital signs, is
you want to check maybe they have an infection in their blood. Maybe there’s infective
material in their blood. So you can do that by
getting blood cultures. Because you want to grow
out whatever is in the blood and see if it’s a fungus
or bacteria or a virus. So blood cultures will allow you to figure out what organism is in the bloodstream. Next, you should probably
figure out how severe the shock is, and if it is in fact shock. Are the organs damaged? What’s going on? You’ll get values such as
lactic acid or serum lactate. Serum lactate is important because it shows you tissue perfusion, when cells of the body are
no longer getting oxygen. So these little orange boxes are cells. When these guys are not longer
getting oxygen, they have to resort through another
way to produce energy. That other way is anaerobic metabolism, metabolism without oxygen. A byproduct of that is
lactate, or lactic acid. So measuring the levels
of serum lactate will tell you just how
oxygen-starved these cells are. Next, you can also get an
ABG, or an arterial blood gas. That will tell you how much
oxygen is in the blood. It will also tell you
other things like the carbon dioxide, different blood gases. And then you’ll get some other lab tests that are maybe organ specific. So, for example, you might want to get a BUN or a Creatinine. These are specific tests for the kidney. I’m only going to write
down these tests for the kidney, but you might want to get the other tests for other organs as well. Now, the lab values for
the kidney are especially important because if the
kidneys are deprived from oxygen for just a little while,
they can actually be damaged. So they’re more readily
injured by lack of oxygen. So these are good labs to get. Now, once all these labs
are in the work, the next logical step is to immediately
treat this patient. Treatment is associated with mortality. The sooner the patient is treated, the more likely it is
that they will survive. So they’ll have decreased mortality if they’re treated more quickly. The treatment usually starts with just very broad spectrum antibiotics. Broad spectrum antibiotics. Now, why broad spectrum? Well, when you first
treat sepsis, you’ll have drawn a blood culture, but you won’t have the results back yet. So you’ll have to start
with an antibiotic that can treat many different
types of infections. Gram-positives, gram-negatives. Many different types of bacteria. If the patient does not really get better with
broad-spectrum antibiotics, use of anti-fungals may also be indicated, because it could be a fungal infection. Usually you start here. Broad-spectrum antibiotics. Then you’ll check the
blood cultures afterwards. Once those cultures
return, the patient can be switched to a more tailored antiobiotic therapy to provide an
antibiotic or an antimicrobial that the organism is susceptible to. Now remember, not only
is there an infection going on, but as a
byproduct of this infection, the patient has a drop in blood pressure. So, treatment will also
include IV fluids to restore blood pressure, as well as a medication called pressors. What pressors do is they help squeeze down blood vessels to allow
an increase in systemic vascular resistance, or
resistance of blood vessels, which helps restore the
blood pressure as well. So, both of these will
increase blood pressure. So treatment will likely
take days to weeks. In the meantime, while
the patient is recovering, what do you think the
next logical step is? You know, the patient
has been diagnosed with septic shock, they’re
being treated for it. So the next step is really to see how the progress of the patient is. What’s the progress of the infection? To check the progress, you know, you might continue to get lactate,
ABG, BUN and creatinine to monitor the patient, but you can also get other labs such as a CRP or an ESR. Now CRP stand for C-reactive protein and ESR stands for erythrocyte
sedimentation rate. Really, the names of these
are somewhat inconsequential. The main idea here is you
can track inflammation. So these allow you to track inflammation. When a patient is first
diagnosed with septic shock, these values are going
to be very elevated. Possibly up around 100. Each of these. Just to give you an idea,
the normal value of CRP should be less than one
milligram per deciliter, and the normal ESR really depends on age. It will be probably below 20 or maybe 25 millimeters per hour. That’s the units of ESR,
erythrocyte sedimentation rate. So CRP and ESR, as I was saying, may be drastically elevated. So resolution of septic shock will show these values starting to
go back down to normal, so searching for a down trend
of these elevated lab values. So really that’s it with septic shock. It all makes sense based
off of what’s going on. Infective material in the bloodstream. Let me make a couple final points. You’ll always want to
start with blood cultures before you do antibiotic therapy. This is very important
so that the organism in the patient’s bloodstream
can be discovered. If broad-spectrum antibiotics are started before blood cultures are obtained, you know there will be
antibiotics in the blood. So when a lab technician
goes to culture it, those antibiotics might interfere with the growth of the blood cultures. So always blood cultures
first, and then antibiotics. But also, another great thing to note is these should not be delayed. Because remember, delay in treatment can lead to increased mortality. And last of all, in many
hospitals you might hear the term, two large bore IV lines
for IV fluid treatment. Essentially, that’s
establishing two lines in either arm in which fluids
can get to the patient. They’ll be called large bore because they’ll be very large in diameter. These tubes will have
a very large diameter. This allows for IV fluid to
get to the patient quicker so that blood pressure can
be increased very quickly. So remember the steps. Diagnosis, treatment, and then tracking progression of septic shock.

17 Comments

  • manevals says:

    Your mouse is going crazy dude…take a lemon head

  • Eric Strong says:

    A little feedback: The first thing to check when trying to diagnose septic shock isn't a bunch of lab tests, but rather an examination of the patient (which goes beyond just a check of the vitals).  Blood cultures are not used to diagnose septic shock, they are used to identify its etiology.  The foundation of shock treatment is prompt restoration of normal hemodynamics; in other words, fluids and vasopressors are more important and time critical than antibiotics.  Using CRP and ESR to monitor "progress" in the treatment of septic shock is simply not done in real life.  These tests are meaningless in this situation.  The best way to monitor progress is to serially examine the patient (tracking vitals, monitoring CVP, following mental status, etc…), monitor urine output, and follow Cr and lactate.

  • Nicole Mills says:

    All these videos over shock are great and really help put a visual to my notes and what is happening in the body! Thanks for making these! 🙂

  • Jor Nic says:

    I agree……for test purposes, unfortunately, this is what they expect you to know. We all know the test world is unrealistic, ironically. However, thank you Khan Academy for your visual explanation….extremely helpful.

  • sunshine abdu says:

    THANK YOU SO MUCH 🙂

  • Reem Hussain says:

    u saved my life! my seminar is next week,veary excellent explanation

  • anderw andrew says:

    Metabolic Theory of Septic Shock
    Please do a search for the above
    Core tip: For decades septic shock has been attributed to an over-active immune response. However, immune modulation has failed to reduce mortality, casting doubt on a direct causal role for the immune response in the development of septic shock. A closer look suggests that septic shock is the result of a generalized build-up of hydrogen peroxide, a toxic cellular by-product generated as a consequence of the hypermetabolic state that accompanies a systemic immune response. This finding points to the systemic accumulation of hydrogen peroxide as a significant risk factor for the development of septic and non-septic shock syndromes.

  • tere williams says:

    Most valid so please listen.

  • swish1onu says:

    Clear concise presentation, much appreciated.

  • john cobain says:

    I have a boil on my thigh. Will that alone cause septic shock even though it been day one ?

  • Scott Macaluso says:

    Thank you so much! Keep them coming!

  • Sharda Shah says:

    please stop moving and jiggling your mouse around, I can't even look at the screen

  • DP3NY 2016 says:

    Good stuff, man. I like that u move the mouse around to emphasis on whats important!! Thanks!!

  • amiyakalyan samaddar says:

    please make it in bengali version

  • chauhan vicky says:

    my mother is suffering from spectic shock. I m very sad but grace of God this time my mother is out of danger thank of God. thankyou very much……for save my mother

  • Kayla Smith says:

    too much movement of the mouse, its distracting.

  • Tsitsi Ruvai says:

    The video is soo helpful,thanks ☺️

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