Septic shock

Septic shock is a life-threatening condition. It happens when your blood pressure drops to a dangerously low level after an infection.

Any type of bacteria can cause the infection. Fungi such as candida, and viruses, can also be a cause, though this is rare.

At first, the infection can lead to a reaction called sepsis. This begins with:

• weakness
• chills
• a rapid heart and breathing rate

If sepsis is left untreated, toxins produced by bacteria can damage the small blood vessels and make them leak fluid into the tissues around them. This can affect your heart's ability to pump blood to your organs. Your blood pressure falls as a result, and blood doesn't reach vital organs such as the brain and liver.

You think that you or someone in your care has symptoms of septic shock, such as:

• low blood pressure (hypotension) that makes you feel dizzy when you stand up
• a change in your mental state, like confusion or disorientation
• diarrhoea
• nausea and vomiting
• cold, clammy and pale skin

People with a weakened immune system are more likely to develop septic shock. This includes:

• newborn babies
• elderly people
• pregnant women
• people with long-term health conditions, such as diabetes, cirrhosis or kidney failure
• people with lowered immune systems, such as those with HIV or AIDS or those receiving chemotherapy

If you have septic shock, you'll usually be admitted to an intensive care unit (ICU). There, your body's functions and organs can be supported while the infection is treated. In some cases, treatment may start in the hospital emergency department.

Treatment may include:

• oxygen therapy
• fluids given directly through a vein (intravenously)
• medicine to increase your blood flow
• antibiotics
• surgery (in some cases)

To help you breathe more easily, you'll be given oxygen. This can be through a face mask, a tube placed in your nose, or an endotracheal tube placed in your mouth. If your shortness of breath is severe, a mechanical ventilator may be used.

You'll probably be given fluids straight into a vein. This raises your blood pressure, because there's more fluid in your blood.

To get more blood flowing to vital organs such as your brain, liver, kidneys and heart, you may be prescribed inotropic medicines or vasopressors.

Inotropic medicines, also called inotropes, are used in septic shock. Dobutamine is one example. These medicines stimulate your heart and make each heartbeat stronger, so more oxygen-rich blood reaches the tissues and organs that need it.

The medicines used in septic shock to raise blood pressure are called vasopressors. They include:

• dopamine
• adrenaline
• noradrenaline

These medicines make your blood vessels narrow. That raises your blood pressure and improves the flow of blood around your body, so your vital organs can start working properly again.

Doctors often use antibiotics to treat the bacterial infection behind septic shock. Which antibiotic they choose depends on the type of bacterial infection and on where in the body it started.

You may be given antibiotics straight away, because this improves your chances of survival. At first, two or three types of antibiotics may be used together. Once the bacterium causing the infection has been identified, the doctors can switch to the type of antibiotic that works best against it.

In severe cases of sepsis or septic shock, blood pressure and blood flow can fall very sharply, and this can kill organ tissue. When that happens, you may need surgery to remove the dead tissue.

The chances of surviving septic shock depend on:

• the cause of infection
• the number of organs that have failed
• how soon treatment is started

The complications can include:

• inability of the lungs to take in enough oxygen (respiratory failure)
• the heart not being able to pump enough blood around the body (heart failure)
• kidney failure or injury
• abnormal blood clotting

These are serious health conditions, and they need urgent treatment. Septic shock can be fatal because of complications like these.