53 - Severe sepsis and septic shock

Summary

This chapter discusses the management of infectious disease emergencies that includes severe sepsis and septic shock. The clinical presentation includes hypotension, encephalopathy, acute kidney injury, cardiogenic shock, lung injury or acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). Early goal-directed therapy (EGDT) is the mainstay of treatment of sepsis. Patients with persistently low blood pressure despite adequate fluid administration or whose resuscitation goals are not met require additional interventions. The risk factors for healthcare-associated infections that may be multidrug resistant are: hospitalization within the last 90 days, residence in a nursing home or long-term care facility, presence of indwelling catheters, intravenous therapy, wound care, or intravenous chemotherapy within the prior 30 days, and attendance at a hospital or hemodialysis clinic within the prior 30 days. Urgent surgical consultation should be sought when indicated by the source of infection (e.g. abscess, ruptured viscus).