Sun28November0333PM 35

A 50-year-old woman presents with two days of fever, rigors and dysuria. She is aggressively fluid resuscitated.

Her heart rate is 120 beats per minute, respiratory rate 30 breaths per minute, systolic blood pressure 80 mmHg and temperature is 39°C.

The following investigations are available:

C reactive protein (CRP) 150 mg/dL (<10)

White cell count 22 ×109/L (3.2-12)

Neutrophils 16 ×109/L (1.9-7.7)

Which one of her observations indicates septic shock?

(Please select 1 option)

Respiratory rate

Systolic blood pressure Correct

CRP

Heart rate

White cell count

Explanation

Sepsis is a broad term applied to an incompletely understood process and recently there has been an attempt to redefine the definitions of sepsis and septic shock. There are, currently, no simple and unambiguous clinical criteria or biological, imaging, or laboratory investigations that uniquely identify the septic patient.

The new definition attempts to draw upon up-to-date pathobiology and distinguish between sepsis and uncomplicated infection. A new tool has been developed for this purpose - the SOFA or qSOFA.

The qSOFA (Quick SOFA) criteria are:

Respiratory rate > or equal to 22/min

Altered GCS

Systolic blood pressure < or equal to 100mmHg

Septic shock is defined as "a subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to substantially increase mortality. This changes from the previous definition to recognise the importance of cellular abnormalities.

Septic shock is defined by persisting hypotension requiring vasopressors to maintain a mean arterial pressure of 65 mm Hg or higher and a serum lactate level greater than 2 mmol/L (18 mg/dL) despite adequate volume resuscitation.

In this case, the patient meets criteria for sepsis, but what marks her out as likely septic shock is her persistent hypotension despite aggressive fluid resuscitation. Here, a lactate would potentially be useful to demonstrate the changes at the microvascular level, and inotropes should be considered.

References:

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

Answer Statistics

1

7%

2

88%

3

3%

4

1%

5

4%

Times answered: 331