septic shock

It's a Staph bacteria that is, um, resistant to the majority of antibiotics that we have, and it tends to be very aggressive and cause very serious infections sometimes.

And so they knew he was in septic shock from MRSA.

They had finally gotten to the bottom of what was slowly draining the life from Zach, MRSA, that had developed into sepsis.

Here's Dr. Jim O'Brien, the vice president of operations for population health at OhioHealth and a board member of the Sepsis Alliance.

What sepsis is is when those body defense systems actually go haywire, and so instead of having a focused response to the infection, you wind up with widespread response to infection throughout the body.

And so your body functionally suffers friendly fire from your immune system trying to battle the infection.

If you experience septic shock, the risk of dying goes up by about 1% for every five minutes that passes without appropriate antibiotics.

Zach had gone into septic shock because of how rapidly the MRSA had spread throughout his body.

It comes from intensive care and emergency teams in Australia and New Zealand.

They took 1,000 adults in the emergency department with septic shock.

Everyone had already had at least a liter of fluid, and the pressure was still low.

So exactly that first page.

So three reflexes this week.

Fluid for a low pressure.

In early septic shock, pressors first did about as well with half the extra fluid.

Bicarbonate for a low pH.

Mm-hmm.

So in someone whose observations have started to go off, tell us about septic shock in pregnancy and how that's different from outside pregnancy.

In pregnancy, um, septic shock is, is often the very last stage before death, and you may not have a gradual decline into septic shock.

It may be, um, as we were just saying, like compensating, compensating, and then wham, bam, you're in septic shock, and it can be, particularly if it's a group A streptococcus that's causing it, by then you've got such bad end organ damage, it can be really difficult to resuscitate the patient.

The definition of septic shock itself is unchanged in pregnancy compared with non-pregnant.

The screening tools that we have before then, so i.e., what blood pressure we'll use, what pulse rate we will use, might be slightly changed according to, as you were saying, pregnancy and which, um, area and territory you are practicing in.

And I guess we look at other things rather than just numbers.

Again, our, our cutoff for lactate might be slightly different in pregnancy compared with the non-pregnant.

I'm Dr. Lisa Johnson.

This week we feature new research on transcatheter treatment for tricuspid regurgitation, multi-cancer early detection testing, resuscitation strategies for septic shock, and an experimental approach to restoring vision.

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Vasopressors or fluids in early septic shock.

By the ARISE fluids investigators, the ANZICS clinical trials group, and the ACIM Clinical Trials Network.

What do our listeners need to know about that?

Yeah, so the 2024 Surgical Infection Society guideline recommends source control within 12 hours for lower-risk patients and within six hours for higher-risk patients with septic shock.

These are both Grade 1B recommendation.

The 2026 Surviving Sepsis campaign similarly suggest early source control, ideally within six hours of the diagnosis of sepsis or septic shock when a source control procedure is required, although the certainty there is pretty low.

Yeah, so the antibiotic order is not, you know, the completion of sepsis care, right?

Exactly.

Those statements shouldn't carry equal weight when discussing them on rounds.

And modern ICU stewardship includes how we administer therapy.

is.

Septic is something she's got.

She's so septic right now, but I have to have goals of care again with the family because.

The decision maker believes very.

Um, and for five days it was just sick, fever, not feeling good, throwing up everything I ate.

Um, the fifth day after I was home I went into septic shock-

Oi

... which is an infection-

I don't know when they'll let me out, when they'll, you know...

But my brother, who's an EMT, was like, "This is not okay," you know? "You gotta take her." So Hatzalah came.

At that point I'm already going into septic shock.

Um, and they took me away again.