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Septic shock
 Pathophys: infection/inflammatory state --> release of mediators (heparin, bradykinin, LTE, PG) -->
vasodilation --> SVR decrease --> afterload decrease --> easier for blood to be ejected from the heart --
> CO increases --> LA/RA = PCWP/CVP pressures decrease (blood is moving forward through the heart)
o Mixed venous oxygen saturation = increased
 = O2 sat of blood that is in the RA = blood that has returned from all the veins in the body
 Fixed principle: CO = O2 delivery/(O2 content of arteries - O2 content of veins)
 Septic shock: CO increases --> difference in O2 artery-venous should decrease --> O2
content of veins goes up (MVO2 goes up)
o *CO and SVR go in opposite directions in shock*
 (only exception is neurogenic shock)
 SIRS+ criteria: >= 2 criteria
o Temperature <36C or >38C
o HR >90 bpm
o RR >20 bpm
o PaCO2 <32
o WBC >12000 or <4000
o with source of infection = septic shock
 + lactic acidosis (low HCO3 or pH) or end-organ damage = severe sepsis
 Tx
o Broad spectrum abx (make sure to cover MRSA or pseudomonas)
o Fluids
 MAP increases
o Norepinephrine
o Remove indwelling catheter if that is source of infection
Neurogenic shock
 Pathophys: high spinal injury, spinal cord surgery, SEA --> @spinal cord thoracic levels --> take out
sympathetic nervous system --> lose vascular tone --> SVR decrease, CO decrease
o *the only kind of shock where SVR AND CO are low*
Cardiogenic shock
 Pathophys: cardiac tamponade, CHF, post-MI --> CO decreased (heart cannot pump fluid forward), SVR
increased --> fluid backs up in the heart --> CVP/PCWP increased
o CO is low --> tissues get very efficient at extracting oxygen --> O2 sat of blood returning to RA is
very low (MVO2 decreased)
 Tx
o Positive inotrope = digoxin, dobutamine (b1 agonist), milrinone
 Milrinone = PDE inhibitor --> increased cAMP --> increased cardiac contractility, decreased
vascular resistance
 Pulse pressure increases due to increased SBP + decreased DBP
Hypovolemic shock
 Pathophys: bleeding out --> body volume goes down --> preload goes down --> CO decreased, SVR
increased --> PCWP/CVP decreased, MVO2 decreased
 Tx: fluids

 *QSOFA criteria (1+): AMS, RR >=22, SBP<=100* used clinically