UMEM Educational Pearls

Things to Consider for Persistent or Worsening Septic Shock

  • Septic shock is one of the most common critical illnesses in emergency medicine and critical care.
  • Norepinephrine is recommended as the initial vasopressor of choice for patients with septic shock, with vasopressin or epinephrine commonly added as a second vasopressor for patients with refractory shock.
  • While vasopressors are being added and titrated, it is important to consider additional diagnoses in patients with worsening or persistent septic shock.  Some of these diagnoses include:
    • Undetected infection that requires emergent source control
    • Concomitant causes of shock: cardiogenic, PE, abdominal compartment syndrome, tamponade, adrenal insufficiency
    • Severe acidosis
    • MAP underestimation by a radial arterial line

References

Teja B, et al. How we escalate vasopressor and corticosteroid therapy in patients with septic shock. Chest. 2023; 163:567-74.