Septic shock is the most severe form of sepsis, when the body's response to an infection drops blood pressure so low that organs stop getting enough blood. Early recognition, fluids, antibiotics and early notice to the hospital save lives.
Key symptoms
- Fever or low temperature with chills
- Confusion, sleepiness or a new change in behavior
- Fast breathing and shortness of breath
- Weakness, dizziness and little urine
- Symptoms of the source: cough, painful urination, red skin, belly pain
What you find on exam
- Low blood pressure, fast heart rate and fast breathing
- Skin: mottled and cool, or very warm and flushed
- Delayed capillary refill
- Look for the source: lungs, skin, wounds, IV lines
- Changes in mental status
Tests
- Point-of-care lactate where available; 2 mmol/L or more raises concern
- End-tidal CO2, often low in sepsis
- Blood glucose
- Hospital: blood cultures, blood count, kidney and liver function, urinalysis, chest X-ray
Treatment basics
- Oxygen to keep saturation at 94 percent or more
- IV crystalloid 30 mL/kg for low blood pressure, rechecking the lungs often
- Norepinephrine if pressure stays low after fluids, aiming for a mean arterial pressure of 65 mmHg or more
- Broad-spectrum antibiotics within 1 hour of recognition, after blood cultures
- Sepsis alert to the receiving hospital
Red flags
- Systolic pressure below 90 mmHg or mean arterial pressure below 65 mmHg
- New confusion
- Lactate 4 mmol/L or more
Practice it in Making Synapses
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.