Friday, April 18, 2008


Continuing with my series on shock, let's take a look at the poor guy above. He could be in the ICU for any reason, but let's pretend he was admitted to the hospital because of an infection. If he's on the ventilator (breathing machine) and has that many IV's and monitoring equipment, he could be in SEPTIC SHOCK.

Sepsis (simply put) is an infection that has moved into the bloodstream. Say for example, you stepped on a piece of glass that may have had staph on it. The area on your foot became red, painful, maybe even swollen. You treat it yourself, thinking you can handle the situation. Maybe add some neosporin to the cut and place a bandaid on it. But the staph bug (and if you've read the news lately, you'll know that there are different types of staph infections and they can be real stinkers) is too strong for your immune system.

Pretty soon, you experience fever, chills, malaise. You've probably forgotten about your foot. Now you think you've gotten the flu. You take some tylenol, drink fluids....sleep. Then the worst happens and you aren't even aware because you've lost consciousness. Someone has found you and you're now in the hospital. Heck, you could even be in my ICU~which would be a lucky thing because we are doing a lot to improve your chances of survival.

But what happened? You'd only stepped on a piece of glass. Well, let's look at this clinically. And this information can be used when writing your characters who've been stabbed with knives that may not be entirely clean, or whatever spin your imagination wants to put on it. The process the body goes through is the same. The treatment is the same.

Sepsis is defined as: a serious illness when an infection overwhelms the body, leading to low blood pressure, blood flow, and multi-system organ failure--meaning your lungs, kidneys, and brain will not function properly.

Signs of Septic Shock are similar to hypovolemia, but here is the list:

~Cool, pale extremities
~High or very low temperature, chills
~Low blood pressure, especially when standing
~Low urine output (due to kidney failure)
~Rapid heart rate
~Restlessness, agitation, lethargy, or confusion
~Shortness of breath

Treatment of Septic Shock:

~Drugs to treat low blood pressure, infection, or blood clotting (Drugs we use to support blood pressure are Levophed and Vasopressin and these are infused at continuous rates through and IV. Antibiotics depends on the bug that put you in this condition, but we start broad spectrum ones such as Vancomycin, Meropenem, Zosyn, and there is one other one that escapes me at the moment.
~Fluids by an IV (A LOT OF FLUIDS!! It is not unusual for us to run IV's at a rate of 200ml per hour)
~Surgery (Surgery may be necessary to remove the area of infection)
~Support for any poorly functioning organs (continuous renal filtration for the kidneys and ventilator support for oxygenation are two of the most common)

Diagnosis is key to survival. From ER to admit to ICU, some research says you need to receive your first antibiotics with one hour of arrival and some says within six hours. For more on the most current treatment, google "SURVIVING SEPSIS CAMPAIGN"

Now, when your character gets really, really, really sick. You have a little more information to add a touch of realism.

Good Luck!


luv2write said...

Wow, Kathleen that is interesting. I could see that easily happening to someone.

Question for you. Will a previous tetanus shot keep you from getting staph or going into septic shock?


Dee Ann

Kathleen Grieve said...

Great question, Dee Ann. Tetanus shots protect you against tetanus--also known as lockjaw. This is a serious but preventable disease that affects the body's muscles and nerves. It usually happens as a result of a skin wound that becomes contaminated by a bacterium called Clostridium tetani.

Your immune system is the only protection you have against getting any type of infection, whether it be staph or the common cold.

If your immune system is compromied in any way--examples would be if someone was taking chemotherapy drugs that wears down your defenses; not eating right; not getting enough sleep; or if you have an autoimmune disease such as lupus and diabetes~ your body's defenses are not as strong as they should be.

Hope that answers your question. Thanks for stopping by!