Introduction
Septic shock, a complicating disorder of an infectious condition known as sepsis, has become one of the primary causes of high death mortality of the hospitalized patients. Leading to a lethal outcome in the case of hospital admission of nearly every second patient, it has grown into a severe health care problem. Deeper understanding of septic shock and wider awareness of the reasons leading to the disease, its symptoms, and treatment may become one of the effective ways of reducing the level of hospitalized patients mortality.
Definition and the Nature of Septic Shock
Septic shock as a severe health problem very often leading to lethal outcomes was spoken about years before the scientists and health professional obtained a knowledge about human’s immune system or systemic inflammatory response syndrome. Almost a century and a half ago, a Canadian physician William Osler stated his belief that people are more likely to die from the body’s response to the infection rather than from the infection itself (Gaieski & Goyal 2013, p. 867). The organism’s reaction to an infection is what septic shock is in very general terms.
In fact, there are various definitions of septic shock, and they are constantly evolving with the deepening of knowledge in the field of medicine, treating diseases and anatomical science as the whole. Generally speaking, it is the condition of the human body caused by a response to an infection in a bloodstream (Gaba 2014, p. 1345). It is called so because the scientific term for the spreading of the infection is sepsis. The organism’s reaction usually takes a form of low blood pressure and low blood flow to the vital organs, thus resulting in the organ dysfunction and leading to death. What is more, bacteria, that provoked infection, release endotoxins into blood, thus triggering the functions of the body’s immune system. Together with that, endotoxins lead to a dilation of large blood vessels, i.e. their widening, and the state under which smaller blood vessels start leaking, so that blood drains to tissues causing swelling and lack of oxygen and nutrients in tissues of vital body organs such as heart, lungs, kidneys, liver, etc.
As mentioned above, septic shock is a complication of sepsis that, in turn, may be caused by any type of infection whether it be viruses, fungi or bacteria. Moreover, an infection may spread from any system of a human body. That means that septic shock may be evoked by the infections of reproductive and digestive systems, urinary tract, head, throat, heart, skin, bones or soft tissues infections or such diseases affecting lungs like bronchitis, pneumonia or lower respiratory tract infections.
Pathophysiology and Etiology of Septic Shock
In general, pathophysiology is a course of interaction between the stimuli to a disease, i.e. a pathology in a human body, on the one hand, and a human organism, on the other. Simply speaking, it is the process of development of a disease and the reaction of a body towards it. In the case of septic shock, it is a series of processes regarding the response of immune system to the spreading of infection. To understand the pathophysiology of septic shock, it is of significant importance to understand the one of sepsis because they are inseparable as the latter may progress into the first if not early diagnosed.
As mentioned above, pathophysiology is a series of processes occurring in a human organism. In the case of septic shock, the first process that naturally takes place is the body’s inflammatory response to an infection. After a virus, fungus or a bacterium gets into the blood, the immune system responds with the inflammatory processes that are the natural shield of an organism. The reaction may take a form of spots on the skin, heat, diarrhea, swelling, pain, etc., i.e. the signals that the organs and tissues are not carrying out their functions properly. As the infection protects itself from the immune system’s response, the stimuli that caused it release substances known as cytokines that lead to a formation of clots, dilation of blood vessels and other processes having an impact on the cellular structure of the tissues. At this step of a disease development, the fluids leak to tissues thus entailing lactic acidosis and cellular hypoxia resulting in the increasing level of nitric oxide in a human body that, in turn, is a primary cause of oxygen deficit in blood and tissues (Dunkley & McLeod 2015, pp. 81-82).
Bearing in mind the processes mentioned above, emerges a possibility to understand the symptoms and the etiology of septic shock. Speaking of the symptoms, they are as following: difficulty in breathing, higher or lower than usual body temperature, anxiety, nausea or vomiting, diarrhea, high heart beating rates, fatigue, etc. These are the general signs that may not necessarily point to septic shock so that the potential patient should make some tests. In the case of a disease, the body temperature is less than 96.8 degrees F or more than 104 degrees F. Heart rate level is more than 90 beats per minute, and the respiratory level is more than 30 breaths per minute. Some additional medical tests may be required, and one of them is the number of white blood cells. In the case of septic shock, it is more than 12,000 or less than 4,000. It may also be more than 10% of immature band forms. Nevertheless, two or more symptoms of those mentioned above usually are a prove of septic shock, there are some additional sign that may be taken into consideration such as hypo- or hypertonia, i.e. systolic blood pressure, less than usual urine output, increase in the level of bilirubin and creatinine to more than 0.5 mg/dL, hypoxemia of the arteries, paralytic ileus, abnormal coagulation, etc. (Cawcutt & Peters 2014, pp. 1573).
Speaking of the etiology of septic shock, the disease as it was already mentioned is caused by various types of bacteria and infections. In most cases, it results from the lower respiratory tract and abdominal and gastrointestinal tract infections followed by urinary infections. The least frequent infections leading to septic shock are those of reproductive system, soft tissues and infections provoked by foreign bodies in a human organism (Kalil & Bailey 2015b, para. 66-72). Together with that, there are certain groups of people who are at potentially higher risk including pregnant women, newborns, people of age, drug addicts, those suffering from diabetes or who have been long hospitalized or went through a surgical interference. In fact, the primary criterion for distinguishing a risk group is the state of the immune system, i.e. those with a strong immune system are less likely to fall victims to septic shock rather than those with a suppressed immunity.
Types of Septic Shock
Based on the symptoms mentioned above, septic shock as a disease may have two types, hyperdynamic and hypodynamic or simply warm and cold septic shock. The primary criterion for the division into two types is the body temperature and the rated of heartbeat and breathing (Wahl n.d., para. 14). That said, in the case of warm, i.e. hyperdynamic, septic shock body temperature is higher than 104 degrees F, high respiratory rate and the number of heartbeats per minute together with an increase in the number of white blood cells. What is more, the visible symptoms are redness of the skin, diarrhea, and confusion.
As of a so-called cold, hypodynamic, septic shock, it is a direct contrary to the first type. Patients who suffer from this type of the disease usually have a low body temperature that is less than 96.8 degrees F, the number of white blood cells is decreased as well as are the heartbeat and respiratory rates. Together with that, they are in most cases pale or have discolored spots on their skin, they feel extremely weak and may experience fatigue.
One more criterion for the division of septic shock into two types is the organs they usually attack. In the case of a warm septic shock, organs under a danger of potential dysfunction are heart and lungs, while in the case of a second type liver and kidneys are most often affected. Nevertheless, it should be borne in mind that the above-mentioned is the general case that may have exceptions to it and that septic shock is a disease that may impact any vital body organ no matter what the initial symptoms are. Moreover, the symptoms may change, so, there may be warm and cold stages of the disease.
Treatment of Septic Shock and the Medication Used
Septic shock is a serious human body condition leading to lethal outcomes in nearly 50 percent of all the cases, so it is of significant importance to not only understand the reasons leading to it and the processes that occur in the organism but also the treatment and medication that should be used to help patients. Basically, there are three major steps in medical treating of septic shock: identifying the infection that caused a disease, prescribing medication to eradicate it and support proper functioning of the patient’s vital organs, and preventing complications such as organ dysfunction and death.
First, and most vital step in treating those suffering from septic shock is diagnosing a disease as soon as possible. Once a potentially sick person came with the symptoms mentioned above, all the necessary laboratory tests should be done. The most important tests are blood chemistry, coagulation studies, urine analysis, the study of blood cultures and soft tissues, etc. All of these laboratory tests are used to find out what is the initial cause of the disease so that the patient could be given relevant treatment and medication. Together with the laboratory tests, some radiologic studies should be carried out so that there is a possibility to find out what organs are under the risk of mal- or dysfunction. Among these studies, there are chest and abdominal radiography, abdomen or head computer-assisted tomography, and abdominal ultrasonography (Kalil & Bailey 2015a, para. 18). Carrying out all the tests and studies mentioned above allows detecting the initial infection that caused the disease and the organs under threat.
When all the necessary tests are done, and septic shock is diagnosed, next step is prescribing proper medication that will eradicate the initial infection and supporting the proper functioning of the vital organs in case they are affected by the disease. When prescribing medication, one realizes the necessity of a great amount of tests and studies that were listed above. The reason for it is that there is an extreme need for the correct conditioning of the bacteria causing infections because the slightest mistake in prescription might as well entail lethal outcomes.
As of the medical treatment of septic shock, most significant goals and principles of it are prescribing adequate antibiotics as early as possible thus stopping the spread of the infection, using supporting measures to deal with the symptoms, treating detected infection with antimicrobial therapy, surgery or, if needed, both, so that it is totally eradicated, maintaining adequate functioning of the patient’s vital body organs so that it is possible to prevent the most negative consequences of the disease and, in the worst cases, treat the complications of septic shock saving the patient from lethal outcome.
Medication is the most vital step in the whole process of treating septic shock and avoiding possible complications. When it comes to using medical treatment, doctors prescribe a great variety of medicinal products. First of all, as it was already mentioned, specialists prescribe antibiotics. This may be a wide range of products based upon the origin of the infection and the stage of treating the patient. Together with antibiotics, the doctors prescribe medication from other groups such as volume expanders, corticosteroids, andrenergic agonists, etc. (Kalil & Bailey 2015a, para. 22). If the detection of the initial infection and the choice of medical products were correct, it is considered to be one of the most effective ways of treating septic shock.
However, sometimes there are cases when medication is not enough to cure the disease. Most frequently, it is the circumstance when the patient has waited for too long so that the vital organs are already damaged, in the cases of focal infections when they cannot be treated with medication, e.g. “intra-abdominal sepsis, empyema, mediastinitis, cholangitis, pancreatic abscesses, pyelonephritis or renal abscess from ureteric obstruction, infective endocarditis, septic arthritis, infected prosthetic devices, deep cutaneous or perirectal abscess, and necrotizing fasciitis” (Kalil & Bailey 2015a, para. 24). In such an instance, arises the need for a surgical interference though preceded and followed by a course of antibiotics. Nevertheless, sometimes it is possible to avoid surgeries, for example, percutaneous drainage of abscesses is preferred to surgical (Solomkin 2010, p. 158), however, it may be absolutely impossible in the case of deep abscesses.
One more way of treating septic shock is known as source control. Even though the cases of infections caused by foreign bodies are rare, there is the possibility of contagion in that way. Source control is the removal of such foreign bodies the examples of which are catheters, cannulas, prosthetic joints, mechanical valves, etc. Sometimes this procedure, however, requires surgical interference.
Together with proper medication and surgical assistance, it is crucial to remember that the primary goal of treatment is preventing vital body organs from dysfunction and saving a patient from the lethal outcome. This step involves maintaining the adequate functioning of the organs based of what they are affected by. For example, if the human organism suffers from oxygen deficit, there are special procedures aimed at oxygenating tissues or if a patient suffers from severe problems with breathing, the ventilation treatment helping in carrying out respiratory body functions may be used. The most radical decision is transplanting healthy body organ. The same is fair in the case of the deficit of body fluids or focal infections damaging them. Under such circumstances, the doctor may fall upon the procedure of blood transfusions. Except for the treatment components mentioned above, one of the most significant of them is providing the patient with adequate nutrition and the needed amount of vitamins, so that the positive outcome is most likely to have place.
As of the next step in the treatment of septic shock, it is the prevention or treating the complications of the septic shock. Bearing in mind everything that was mentioned above about the symptoms and the treatment, it is important to say that the most efficient way of dealing with any disease including septic shock is to remember that health is precious and that it is better to prevent an illness rather than treat it. That said, raising awareness concerning the symptoms and the severity of the outcomes as well as the ways to prevent infections might help reduce the death mortality among the hospitalized patients.
Speaking of the prevention of the disease, it does not mean that we have to rush to a hospital every time the body temperature, heart rate or respiratory rate are higher than normal, it just means that we should listen to our body signals and note if some of them are alarming. Together with that, if is strongly recommended to undergo medical and laboratory tests every once in a while and, what is more important, never neglect the infections we know about and treat them properly. For example, knowing that septic shock in many cases was caused by respiratory system infections such as pneumonia it is better to control complete recovery thus exclude the possibility of complications.
Conclusion
So, septic shock is a major illness caused by the spread of infection in the blood thus resulting in vital body organs dysfunction and, eventually, death. It is the reason of nearly half deaths of the hospitalized patients. With such extreme rates of mortality, septic shock has turned into a disastrous problem for a health care system all over the world. This body condition is signaled by a series of symptoms, that is why it is very important to remember that the earlier it is diagnosed, the more chances there are to treat it properly and avoid lethal outcomes. More than that, the treatment of this disease is complicated and costy, and, what is more crucial, not always successful. That said, not only deepening knowledge about the nature and treatment of septic shock may help reduce extremely high mortality rates but also raising awareness and making information about the symptoms as simple and available as possible among the common people who do not have special knowledge in medicine or anatomy.
References
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