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Diagnosis and management of shock in the ICU 

Diagnosis and management of shock in the ICU
Chapter:
Diagnosis and management of shock in the ICU
Author(s):

Antoinette Spevetz

and Joseph E. Parrillo

DOI:
10.1093/med/9780199600830.003.0150
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date: 24 November 2020

Sepsis is triggered by an infection and treatment of sepsis requires timely identification of the patient, and rapid treatment with antibiotics, source control, and fluids. In the absence of a true biomarker for sepsis, the clinician needs to recognize which patients are at risk, as well as the common signs and symptoms of infection. The site of infection, the patient’s phenotype, and the location of the patient will help drive decisions about initial antibiotic therapy. Patients with sepsis should be treated to ensure adequate cardiac output and organ perfusion, which usually requires infusion of intravenous fluids. Crystalloid fluids are most frequently infused, and patients will often require large doses in the first 6–24 hours of treatment. In addition to haemodynamic and fluid support, some patients require infection source control. Many sepsis patients require additional supportive therapy with vasoactive agents, mechanical ventilation, renal replacement therapy, and nutritional therapy. The use of these supportive therapies allows for a patients host defence system to work in conjunction with antibiotics to fight off the infection. When using these supportive therapies, the clinician should attempt to minimize the complications of the therapies and the causative infection. Once a patient starts to clinically improve, it is essential that therapies that are no longer necessary are withdrawn. Patients who do not respond to initial therapy should be evaluated for either resistant organisms, persistent sources, or alternate diagnoses.

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