Shock and Sepsis
Types of shock and the Surviving Sepsis Campaign hour-1 bundle
Types of shock
| Type | Cause | Clues | Main treatment |
|---|---|---|---|
| Hypovolemic | Bleeding, dehydration, burns | Tachycardia, cool clammy skin, flat neck veins, ↓ urine | Stop the bleeding; fluids, blood |
| Cardiogenic | Pump failure (MI, HF) | Crackles, JVD, ↓ BP, cool skin | Inotropes, revascularization; careful fluids |
| Septic (distributive) | Infection → vasodilation | Fever or low temp, warm or mottled skin, ↑ lactate | Antibiotics, fluids, norepinephrine |
| Anaphylactic (distributive) | Allergic reaction | Hives, wheeze, swelling | IM epinephrine, fluids |
| Neurogenic (distributive) | Spinal cord injury T6 or above | ↓ BP with bradycardia, warm dry skin | Fluids, vasopressors, atropine |
| Obstructive | Tension pneumothorax, tamponade, massive PE | JVD, ↓ BP; tracheal shift or muffled heart sounds | Relieve the obstruction |
Early shock: restlessness, tachycardia, fast breathing, ↓ urine output, cool skin; BP may still be normal. Hypotension is a late sign.
Sepsis
Sepsis = life-threatening organ dysfunction caused by the body's response to infection. Septic shock = needs vasopressors to keep MAP ≥65 and lactate >2 despite fluids.
Look for: fever or hypothermia, tachycardia, tachypnea, confusion, low BP, mottled skin, low urine output. Older adults may only seem confused or weak.
qSOFA should not be used alone to screen for sepsis. Updated
Hour-1 bundle (Surviving Sepsis Campaign)
- Measure lactate; remeasure if >2 mmol/L.
- Blood cultures before antibiotics (without delaying them).
- Broad-spectrum antibiotics: within 1 hour for septic shock or probable sepsis.
- 30 mL/kg crystalloid (balanced solutions such as LR preferred) for hypotension or lactate ≥4.
- Norepinephrine if MAP stays <65 during or after fluids.
Then: source control, urine output ≥0.5 mL/kg/h, glucose 140–180, reassess fluid status often.
Priority
A patient with infection who becomes newly confused, breathes fast and has a falling BP: call the rapid response team. Every hour of delay in antibiotics for septic shock raises the risk of death.