Sepsis: A Case Study

It knows no boundaries. It is not biased or racist, and it is a killer. It will affect any age or gender. It is cunning, quick to manifest itself, and life-threatening, it is septic shock. Sepsis is a crafty syndrome that most people may not even realize they have until a family member realizes they are acting different and takes them to the emergency department. First it starts with an infection, then early sepsis, which if not treated it turns into septic shock. Sepsis is defined by the Surviving Sepsis Campaign as a “life-threatening organ dysfunction caused by a dysregulated host response to infection (Society of Critical Care Medicine, 2017, p. 489).” Septic shock is defined as a “subset of sepsis with circulatory and cellular/metabolic …show more content…
Severe sepsis is associated with organ dysfunction, hypotension, and hypoperfusion. Along with the previous symptoms lactic acidosis, oliguria, or acute alteration in mental status are evident (Wagner & Hardin-Pierce, 2014, table 36-8). Septic shock is associated with hypotension despite fluid resuscitation, and the other manifestations already mentioned (Wagner & Hardin-Pierce, 2014, table 36-8). As sepsis worsens the patient’s extremities will be cold and mottling may be present, lactate levels rise, and ScvO2 decreases (Wagner & Hardin-Pierce, 2014, p. …show more content…
Norepinephrine is the recommended first-line drug for sepsis, and low-dose dopamine should be used to for renal protection. If the patient is not responding to vasopressors and fluids, IV corticosteroids can be used at a dose of 200 mg per day (Society of Critical Care Medicine, 2017, p. 504-506). Tight glucose control should be maintained. It is recommended that glucose levels should be under 180 mg/dL (Society of Critical Care Medicine, 2017, p. 514). If the patient is ventilated they should be sedated and given analgesic medication (Society of Critical Care Medicine, 2017, p. 513.) Venous thromboembolism prophylaxis should be initiated to prevent blood clots. It is recommended that a low molecular weight heparin be used along with sequential compression devices (mechanical prophylaxis). A proton pump inhibitor or histamine-2 receptor antagonist should be used to prevent stress ulcers if there is a high risk for gastrointestinal bleeding (Society of Critical Care Medicine, 2017, p. 516-518). Nutritional therapy should be initiated twenty-four to forty-eight hours after admission to address the hypermetabolic state (Hinkle & Cheever, 2014, p.304). Enteral nutrition is recommended route of administration (Society of Critical Care Medicine, 2017, p.