How do you define sepsis?
SIRS plus a source of infection.
Okay. SIRS plus a known source of infection
is sepsis. How do you define septic shock?
Yeah. What's the word you're looking for?
Refractory hypertension, is refractory to fluid resuscitation.
So you can have a patient with shock,
but then if you give them fluids,
they become normovolemic or normotensive.
But in a patient with septic shock, peripheral
vasodilatation, pooling in the peripheries,
so even if you give fluids, they're not going
to respond. So that is septic shock. So that's
the difference between shock and septic shock.
I have a question. No. Not at all.
happens is, somebody sustains a burn at say
12 midnight, by the time you see them it's
four o'clock, 4 a.m. So by 8 a.m.,
you should have given the first half
of the fluid. Clearly, you can’t, because
you got only four hours to catch up. So what
we tell you, what we normally do, is try
to titrate whatever you can give in these
four hours, and then catch it up in the next
couple of hours. Okay? So you have to be a
bit careful of pushing so much of fluid just
because you have to stick to the guideline.
You can of course, you can give a couple of
litres of Hartmann’s as a bolus. But you
have to be careful. The more fluid you push
in, you increase the hydrostatic pressure
significantly, and that just leaks out. So
in burns or any situation, you try to see
why I don't really give 2 litres bolus, I’ll
go for a litre bolus and the next litre pretty
fast, maybe an hour or two. You don't want
to give it as bolus.
Clinical signs of shock. I’m sure
you know this. I’m not going to waste time on this.
Hypotension, tachypnoea, oliguria,
agitation, confusion, coma, slow capillary
refill. So these are all signs of SIRS,
these are signs of shock. Yeah it is, the
What type of antibiotics do you give in...
In septic shock? It depends on where is the
source of infection. If it’s an orthopaedic
patient, you go for more of a Cef and Met-Augmentin
route. If it is bowel, then you have to cover
for coliforms. So in the exam if you get something
like a third generation cephalosporin, cefotaxime,
that's quite safe. What do you say? Amoxi-Met and Gen,
yes, that can be used as well.
But for the purpose of the exam it's the cephalosporin?
Cephalosporin. Yeah, cephalosporin, yeah.
Now one thing you may be missed in sepsis
and is very important, but then you have to
support every system. Ionotropes, that has
got a very important role. So if at all, you
are given a choice, an option of considering
ionotropes, be very careful to discount it,
because septic shock, you need to peripherally
vasoconstrict with some noradrenaline to increase
the blood pressure. So make sure that
the ionotropes is in your list of priority
in septic shock, mainly gram negative sepsis.
What's happening here now? Anything else?
Severely tachypneic, hypotensive and pretty much
oligouric. Anuric, isn't it
You won't get this in the exam, this type
of X-ray, but what do you think it is? ARDS.
Yeah okay. But you need to know about ARDS in terms
of theory. What's ARDS? How do you diagnose