Septic shock is a severe and potentially fatal condition that occurs when sepsis leads to life-threatening low blood pressure. Sepsis develops when the body has an overwhelming response to infection.
Knowing how to recognize and prevent septic shock is vital. The body usually responds to an infection by releasing inflammatory substances into the bloodstream. These regulate the immune system to fight the infection.
When the body loses control of this response, it triggers damaging changes to the organs. As a result, they can become dysfunctional or even stop working entirely. This condition is called sepsis.
If a person with sepsis has low blood pressure that does not improve with fluid treatment, this means that their body has gone into septic shock. They will need medications called vasopressors to keep their blood pressure high enough to get blood to their organs.
Without this treatment, insufficient blood flow can result in vital organs not getting enough oxygen and beginning to fail, such as the brain, kidneys, lungs, and heart.
Sepsis is often fatal. According to the Centers for Disease Control and Prevention (CDC), it causes the death of about 258,000 people each year in the United States and is the ninth leading cause of disease-related deaths.
Septic shock is also a grave condition with life-altering complications that include chronic pain, incorrectly functioning organs, and post-traumatic stress disorder (PTSD).
This article discusses how to understand the signs and symptoms of septic shock and how to prevent it.
There are a few steps that people can take to reduce their risk of developing sepsis and septic shock:
- Get regular vaccinations against viral infections, such as flu, pneumonia, chickenpox, HIV, and other infections that could potentially lead to sepsis.
- Practice good hygiene, such as bathing and changing clothes regularly. Washing the hands frequently, especially after handling food, touching pets, and using bathroom facilities, is another way to keep infection at bay.
- Care for and clean any open or gaping wounds. Wear disposable gloves, and rinse wounds with clean, soap-free water to clear out debris or dirt. Cover the wound to protect it, and see a doctor if the wound does not close or might still contain dirt.
- Look out for signs of infection, such as fever, chills, rapid breathing, rash, or confusion.
- For any bacterial infections, follow the doctor’s advice on how to take the antibiotics and finish the whole course of treatment. Store the medicine according to the packaging instructions.
- Treat fungal and parasitic infections as soon as symptoms appear, and use medication specific to the particular fungus or parasite.
- Control diabetes, if relevant.
- Avoid smoking
Hand-washing tips for people with compromised immunity
People with compromised immune function should take extra care when washing their hands and follow the steps below:
- Remove rings and watches when possible to clean the areas of skin beneath them.
- Add warm, running water to the skin on the hands and wrists.
- Lather liquid soap onto the hands, being sure to include the skin between the fingers.
- Spend 10–15 seconds washing the hands.
- Use a towel to turn off the tap to prevent recontamination.
Sepsis is a very severe illness, and immediate, intensive treatment is crucial for surviving the condition and preventing septic shock. People with sepsis and septic shock require hospitalization for close monitoring and treatment.
Studies have shown that the risk of death from sepsis and septic shock increases with each hour before the administration of antibiotics.
Doctors use the following medications to treat sepsis and septic shock:
Antibiotics: Treatment should begin within the first 6 hours after diagnosis. The doctor will administer these drugs directly into a vein.
They will usually start treatment with broad-spectrum antibiotics that act against most of the bacteria that could be causing the infection.
Once the blood test results have revealed which bacteria is responsible, the doctor is likely to switch to a more specific antibiotic.
Vasopressors: These medications are necessary to maintain adequate blood pressure in people with septic shock. A doctor will use these if blood pressure remains too low after a person receives fluids.
Vasopressors work by tightening the blood vessels to increase blood pressure. If the blood pressure continues to drop with this medication, the situation is a cause for concern.
Corticosteroids: Doctors use these when blood pressure and heart rate continue to be unstable even after they have received fluids and vasopressors.
Additional medications may include insulin to stabilize blood sugar levels and drugs to alter the response of the immune system. In some cases, a person might require surgery to remove an abscess, which is a sealed-off collection of pus, to stop the infection.
People with severe sepsis and septic shock usually need to be in an intensive care unit (ICU) as they may require oxygen, mechanical ventilation, intravenous (IV) fluids, and vasopressors. Depending on the severity of their condition, some individuals may also have to undergo dialysis because of kidney failure.
The most common cause of sepsis is a bacterial infection. Sepsis can then lead to septic shock.
Whenever bacteria find their way into the bloodstream, harmful infections might occur.
Bacteria or other infectious agents can get into the bloodstream through an opening in the skin, such as a cut or burn.
Sepsis can also be the result of an infection in an organ, such as a urinary tract infection (UTI) or lung infection. Fungi and viruses can also cause sepsis, particularly in people with weakened immune systems, but this is less common.
Some of the most common conditions that can lead to sepsis include pneumonia and infections of the abdominal area, kidneys, and urinary tract.
The following groups of people have a higher risk of sepsis:
- people who are under the age of 1 year or over 65 years old
- those who have a compromised immune system, such as people who have HIV or are receiving chemotherapy
- people who are already unwell or have long-term health conditions, such as diabetes, lung disease, or kidney failure
- individuals with open wounds, injuries, or burns
- those with implanted medical devices, such as IV catheters or breathing tubes
The symptoms of sepsis may vary from person to person, but early signs and symptoms typically include the following:
- shortness of breath
- fever, shivering, or feeling very cold
- extreme pain or discomfort
- a high heart rate
- unexplained confusion or disorientation
- sweaty or clammy skin
Additional symptoms may include:
- common signs of infection, such as fever, diarrhea, vomiting, or a sore throat
- decreased urination frequency
- pale or discolored skin
It is vital to treat sepsis in its early stages before it progresses and becomes septic shock.
An individual is at risk of developing sepsis if they are not in the intensive care unit and meet two or more of the following criteria:
- a breathing rate of 22 breaths per minute or more
- confusion or another sign that the brain is not functioning normally
- systolic blood pressure of 100 mm Hg or less
For a doctor to diagnose sepsis, the individual must have an out-of-control response to an infection that leads to life-threatening dysfunction in one or more organs.
To receive a diagnosis of septic shock, the individual must meet the criteria for sepsis and also requires vasopressors in addition to fluids to maintain adequate blood flow.
It is crucial to identify sepsis and septic shock early.
However, it can sometimes be difficult to recognize these conditions because their symptoms are similar to those of other disorders and there is no specific test to confirm them.
Doctors with limited experience of these conditions can sometimes miss them as the diagnosis requires a collection of different findings. Tests that may help a doctor confirm sepsis and septic shock include:
- Blood cultures: A doctor will draw samples of blood from two different sites in the body and test them for signs of infection.
- Urine tests: If the doctor suspects a UTI, they may ask for a urine sample to check for bacteria and infection.
- Wound secretions: The doctor might test a small sample of liquid from a wound to help determine the best antibiotic to use.
- Respiratory secretions: If the individual is coughing up mucus, the doctor may test it to confirm what type of germ has caused the infection.
In many people, the exact site of the infection will not be apparent. In these cases, a doctor can use imaging scans, such as X-rays, CT scans, MRI scans, and ultrasounds, to help identify infected areas of the body.
Sepsis and septic shock are life-threatening conditions that require urgent medical treatment. Anyone who suspects that they or someone else may have sepsis or have gone into septic shock should seek emergency care.
Early diagnosis and treatment are vital to a good outcome.
How do I know that my symptoms are a result of sepsis rather than a less severe infection?
No single test or symptom can tell you whether or not you have sepsis. However, when you have sepsis, you usually feel much iller than when you have a regular infection.
There are some more distinctive signs and symptoms that can occur in early sepsis. These include a high heart rate, feeling feverish or very cold, shortness of breath, confusion or disorientation, feeling clammy or sweaty, and severe discomfort or pain.
Having any one of these signs and symptoms or a combination of them makes it more likely that you have sepsis. This is especially true if you have had one of the infections that can often lead to sepsis, which include lung, abdominal, urinary tract, and skin infections.
Adults aged 65 years and older and infants younger than 1 year have a higher risk of sepsis. Other people at greater risk include those with a chronic illness, such as kidney or lung disease, diabetes, or cancer, and people with a weakened immune system, possibly due to HIV or chemotherapy.
People who have one or more of these risk factors should be aware of the early signs and symptoms of sepsis and keep an eye out for them whenever they have an infection.Nancy Moyer, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.