Septic shock is a so-called inflammatory reaction of the organism. The body responds to the invasion of viruses, bacteria, fungi, and toxins with multiorgan failure. If timely and adequate treatment is not given, septic shock is usually fatal. Septic shock should be distinguished from anaphylactic shock (allergic shock) and circulatory shock.
What is septic shock?
Blood poisoning or sepsis can lead to septic shock. Septic shock is present when the symptoms of SIRS (systemic inflammatory response syndrome) occur. Furthermore, there must be an infectious cause (bacteria, viruses, fungi, or toxins) as well as a systolic blood pressure below 90 mmHg. The low blood pressure (hypotension) must persist for at least one hour despite volume substitution. In addition to fever and an accelerated heartbeat, the respiratory rate is increased and disturbances in the blood count are present. Septic shock is caused by sepsis (blood poisoning). If organ or multiple organ failure occurs, associated with a drop in blood pressure, this is defined as septic shock. Septic shock can be divided into three stages:
Stage 1: the onset of septic shock – is characterized by: Body temperature above 38.4 °C, stable tachycardia (accelerated heartbeat), hyperventilation, platelet count in the blood is within the normal range, intensive monitoring required. Stage 2: septic shock: decrease in platelet count, hyperdynamic or hypodynamic shock, evidence of bacteremia and endotoxinemia, ventilation of the affected person urgently required. Stage 3a: remission: marked improvement. Or stage 3b: refractory to therapy: no improvement in symptoms, patient’s condition cannot be influenced even by aggressive therapy, so septic shock ultimately leads to death.
Causes
Septic shock is caused by bacteria, viruses, fungi, or toxins that have entered the bloodstream. The introduction of bacteria is often caused by medical procedures, such as punctures, surgery, catheter infections, or by taking certain medications. In most cases, septic shock is the result of sepsis (blood poisoning). However, other diseases such as cancer, end-stage renal disease, Lemierre’s syndrome, gangrene, peritonitis, as well as inflammation of the lungs, pancreas and gallbladder, can also be a cause of septic shock. Sepsis and subsequent septic shock, may also be a result of burns to the skin or other open wounds.
Symptoms, complaints, and signs
Septic shock can cause a wide range of symptoms and complaints. First, the shock reaction causes cardiovascular symptoms: Palpitations, hypertension, and fluctuations in blood pressure. In parallel, blue linens or redness appear under the skin. The skin lesions appear mainly on the extremities and enlarge rapidly. The accompanying sepsis initially causes a severe fever and malaise and leads to serious circulatory problems as the disease progresses. Chills and confusion also occasionally occur. As a result of the fever, hypothermia can also occur, in which the body temperature drops below 36 degrees Celsius. The most obvious sign is the red line that develops toward the heart. The red line may be slightly sensitive to pressure and is clearly visible externally. If it reaches the heart, heart failure is imminent. If severe, sepsis can be fatal. Early treatment prevents serious complications and leads to a rapid recovery without further symptoms or complaints in 80 percent of patients. Occasionally, a protracted fever and physical weakness may occur. These signs of illness resolve completely within a few weeks.
Diagnosis and course
Septic shock is diagnosed by a blood test. Here, the pathogen that triggered the inflammatory chain reaction is searched for. Furthermore, septic shock can be recognized by the course of the disease in sepsis. The first signs are red or blue lines on the arms and legs, swollen lymph nodes, high fever, tachycardia, hyperventilation, impaired consciousness, hypotension and organ failure.Sepsis is usually accompanied by circulatory disturbances, a drop in blood pressure and organ failure. If sepsis is not treated adequately and in time, septic shock occurs as a result. If no effective countermeasures are taken or if the therapy does not work, septic shock is usually fatal. The mortality rate for sepsis or septic shock is approximately 50-60 percent.
Complications
In septic shock, circulatory collapse occurs due to a drop in blood pressure based on poisoning, usually bacterial. Septic shock is therefore always highly life-threatening. The low blood pressure and small blood clots can lead to a number of serious complications. For example, the blood supply to vital organs such as the brain, heart, lungs or kidneys may be impaired. If body tissues do not receive enough blood, they release excess lactic acid, threatening metabolic acidosis. Furthermore, thrombocytopenia may develop because platelet survival decreases due to the progressive poisoning processes. In addition, shock kidney, i.e. acute kidney failure, is to be expected if the urine volume decreases too much. If the lungs are affected, symptoms such as hyperventilation due to oxygen deficiency and shortness of breath may initially occur. In these cases, there is a risk of shock lung, i.e. acute lung failure. Insufficient blood flow to the gastric mucosa in conjunction with increased formation of gastric juice can lead to a stress ulcer, i.e., stress-induced damage to the gastric mucosa. If sepsis cannot be contained, the worst complication is acute multiorgan failure, which regularly leads to death.
When should you go to the doctor?
A doctor must always be consulted for this disease. There can be no self-healing, so the affected patient is dependent on medical treatment. In the worst case, the affected person will die from this shock if the disease is not treated. A doctor should be consulted if the affected person suffers from palpitations and high blood pressure. There is also severe redness of the face and most patients also suffer from fever. If these symptoms occur, a doctor must be consulted in any case. It is not uncommon for those affected to appear confused or suffer from chills and a general feeling of illness. If this shock is not treated, it usually leads to heart failure. In the event of such a shock, an emergency doctor should be called immediately or the hospital should also be visited. Further treatment is then carried out in the hospital, usually requiring a further stay.
Treatment and therapy
Septic shock is a medical emergency and requires prompt medical attention. Depending on the pathogen determined to be the cause of septic shock, drug therapy with antibiotics, antiviralia, antifungals, or antiparasitics is initiated. Furthermore, volume substitution is performed. In addition to preventing exsiccosis (dehydration), the infusion fluid serves to balance the water and electrolyte balance. Since septic shock is associated with multiple organ failure, medicinal measures are also taken to stabilize the affected organs. In septic shock, blood clotting may also be affected, so that measures must be taken to prevent thrombosis or embolism. As a result of the drop in blood pressure, circulation to the extremities and organs is impaired as the condition progresses. Due to the reduced circulation of the blood, a lack of oxygen occurs as a result, which can lead to impaired consciousness and coma. The circulatory disturbance, together with the blood coagulation disturbance, can result in thrombosis, so that in addition to the administration of oxygen and blood thinning agents, increased fluid must be administered. Sepsis or septic shock are often caused by an infected wound. Because of this, it is necessary for the source of infection to be surgically removed. Since breathing is often restricted, intubation is usually performed. In addition to these measures, general measures to maintain circulation are also performed in septic shock.
Prevention
Septic shock can be prevented by ensuring a sterile environment during surgery in hospitals and doctors’ offices.Thorough wound disinfection must be performed after the operation. The daily dressing changes must also be performed under sterile conditions. But it is not only operations in the hospital that can be the trigger for septic shock. Every wound, no matter how small and seemingly insignificant, should be adequately disinfected immediately. For this purpose, there are disinfectants for skin and wounds that belong in every medicine cabinet at home and at work. Some people suffer from poor wound healing. This group should always see a doctor – even for small wounds – to have the wound professionally treated, so that sepsis and septic shock can be avoided.
Aftercare
Anyone who has suffered septic shock may be scarred for life. But the body was strong enough to fight through this severe infection, even if it sustained damage. The task now is to compensate for this damage in the long term. This is generally best accomplished through a healthy lifestyle. This includes, first of all, the diet. It should be light and digestible, as well as rich in vitamins and low in fat. If the kidneys have been affected by septic shock, a low-potassium diet is also recommended. The patient should only resort to fast food in an emergency. Instead, freshly prepared meals with lots of vegetables and salad are recommended. Toxins such as nicotine and alcohol place an unnecessary burden on both the liver and the entire organism. Regular rest periods and sufficient sleep give the body the opportunity to carry out unencumbered repair work. Exercise, which is best done in the fresh air, promotes blood circulation and oxygen intake. The patient may be suffering psychologically after the life-threatening shock situation. Knowing that one almost died can be very stressful. Psychotherapeutic crisis intervention is advisable here. Of course, the patient should also avoid injuries in the future. If he or she does sustain a wound, attention should be paid to its healing process.
What you can do yourself
For patients who have suffered septic shock, many things in life often change. Depending on the severity of the illness, the main concern is a good healing process. Participation in support groups shows those affected how to regain their quality of life. Above all, the immune system needs strengthening to resist new pathogens. To reduce the risk of a physical shock reaction, there are also other useful support measures. Those suffering from diabetes mellitus should stick to the prescribed diet. People with implants, catheters or stents are also at risk and should take good care of themselves accordingly. The risk increases sharply in the case of inflammation, and immune deficiencies can also promote septic shock. For those affected, it is immensely important that they monitor their bodies and notice any problems at an early stage. Regular visits to the doctor are as much a part of everyday life for those at risk as a healthy lifestyle. By attending a self-help group or receiving comprehensive psychotherapeutic care, those affected can learn more about this condition and how best to deal with the constant danger.