Which of the following do you expect to see in a patient with septic shock?

Choice A rationale Obstruction of blood flow is the defining characteristic of obstructive shock, which is caused by physical barriers to blood flow such as a tension pneumothorax, cardiac tamponade, or a massive pulmonary embolism. Septic shock, however, is a type of distributive shock. In distributive shock, the problem is not a physical blockage but rather massive vasodilation and maldistribution of blood flow due to the systemic inflammatory response, which leads to inadequate oxygen delivery to the tissues. Choice B rationale Bradycardia is an abnormally slow heart rate, usually less than 60 beats per minute. In septic shock, the body typically responds to hypotension and hypoperfusion by triggering the sympathetic nervous system, resulting in tachycardia to maintain cardiac output. While certain conditions or end stage shock can cause bradycardia, it is not an expected or classic finding of septic shock. Tachycardia is the expected compensatory mechanism as the heart tries to pump more blood to compensate for low pressure. Choice C rationale Persistent hypotension despite adequate fluid resuscitation is the hallmark diagnostic feature of septic shock. It indicates that the underlying inflammatory vasodilation and capillary leak are so severe that intravenous fluids alone cannot maintain a mean arterial pressure of at least 65 mmHg. This state requires the initiation of vasopressors, such as norepinephrine, to increase systemic vascular resistance. This persistent low pressure leads to cellular hypoxia and the elevation of serum lactate levels above 2 mmol/L. Choice D rationale Uncontrolled hypertension is the opposite of what occurs in septic shock. Shock by definition involves a state of low blood pressure and inadequate tissue perfusion. Hypertension would suggest an entirely different pathological process, such as a hypertensive crisis or autonomic dysreflexia. In septic shock, the systemic vascular resistance is markedly decreased because of the release of inflammatory mediators like nitric oxide, which causes blood vessels to relax and prevents the maintenance of high or even normal pressure.