Shock Case Study
A 77-year-old man is admitted to the intensive care unit (ICU) of a university hospital from the
operating room. Earlier the same day, he had presented to the emergency department with
abdominal pain. His past medical history included hypertension and hypercholesterolemia,
previous heavy alcohol intake, and mild cognitive impairment. In the emergency department, he
was drowsy and confused when roused and was peripherally cold with cyanosis. The systemic
arterial blood pressure was 75/50 mm Hg, and the heart rate was 125 beats per minute. The
abdomen was tense and distended. After the administration of 1 liter of intravenous crystalloid to
restore the blood pressure, a computed tomographic (CT) scan of the abdomen showed
extraluminal gas and suspected extraluminal feces consistent with a perforated sigmoid colon.
He was treated with intravenous antibiotics and taken to the operating room for laparotomy.
During this procedure, gross fecal peritonitis from a perforated sigmoid colon was confirmed;
resection of the sigmoid colon with closure of the rectal stump and creation of an end colostomy
(Hartmann’s procedure) was performed with extensive peritoneal toilet and washout.
On arrival in the ICU, he is still anesthetized, the trachea is intubated, and the lungs are
mechanically ventilated with a fraction of inspired oxygen of 0.4; the arterial blood pressure is
supported with a norepinephrine infusion. When the patient was in the operating room, he
received a total of 4 liters of crystalloid. On his arrival in the ICU, the vital signs are a blood
pressure of 88/52 mm Hg, heart rate of 120 beats per minute in sinus rhythm, central venous
pressure of 6 mm Hg, and temperature of 35.6°C. An analysis of arterial blood shows a pH of
7.32, a partial pressure of carbon dioxide of 28 mm Hg, a partial pressure of oxygen of 85 mm
Hg, and a lactate level of 3.0 mmol per liter.
Question
1) Define and describe a diagnosis of sepsis and septic shock.
Septic shock- occurs when sepsis goes unchecked. It is a life threatening condition caused
by an infection resulting in organ failure and blood pressure drop. Includes critical
reduction in tissue perfusion.
Sepsis- life threatening complication of a dysregulated response to infection
Diagnosis- blood test for evidence of infection, clotting problems, liver and kidney
function, o2, electorlyte
2) Describe the SIRS criteria by listing the four signs of the systemic inflammatory
response syndrome.
Tachycardia (HR > 90 beats per min), tachypnea (RR > 20 breaths per min), temp ( above
38 C or below 36 C), and leukocytosis or leukopenia (WBC > 1200/mm3 or <
4000/mm3)
3) Describe the difference between a diagnosis of SIRS and a diagnosis of sepsis
Sepsis: Sepsis is the body’s extreme response to an infection. It is a life-threatening
medical emergency. Sepsis happens when an infection you already have triggers a chain
reaction throughout your body. Sepsis can lead to death if not treated in time
A 77-year-old man is admitted to the intensive care unit (ICU) of a university hospital from the
operating room. Earlier the same day, he had presented to the emergency department with
abdominal pain. His past medical history included hypertension and hypercholesterolemia,
previous heavy alcohol intake, and mild cognitive impairment. In the emergency department, he
was drowsy and confused when roused and was peripherally cold with cyanosis. The systemic
arterial blood pressure was 75/50 mm Hg, and the heart rate was 125 beats per minute. The
abdomen was tense and distended. After the administration of 1 liter of intravenous crystalloid to
restore the blood pressure, a computed tomographic (CT) scan of the abdomen showed
extraluminal gas and suspected extraluminal feces consistent with a perforated sigmoid colon.
He was treated with intravenous antibiotics and taken to the operating room for laparotomy.
During this procedure, gross fecal peritonitis from a perforated sigmoid colon was confirmed;
resection of the sigmoid colon with closure of the rectal stump and creation of an end colostomy
(Hartmann’s procedure) was performed with extensive peritoneal toilet and washout.
On arrival in the ICU, he is still anesthetized, the trachea is intubated, and the lungs are
mechanically ventilated with a fraction of inspired oxygen of 0.4; the arterial blood pressure is
supported with a norepinephrine infusion. When the patient was in the operating room, he
received a total of 4 liters of crystalloid. On his arrival in the ICU, the vital signs are a blood
pressure of 88/52 mm Hg, heart rate of 120 beats per minute in sinus rhythm, central venous
pressure of 6 mm Hg, and temperature of 35.6°C. An analysis of arterial blood shows a pH of
7.32, a partial pressure of carbon dioxide of 28 mm Hg, a partial pressure of oxygen of 85 mm
Hg, and a lactate level of 3.0 mmol per liter.
Question
1) Define and describe a diagnosis of sepsis and septic shock.
Septic shock- occurs when sepsis goes unchecked. It is a life threatening condition caused
by an infection resulting in organ failure and blood pressure drop. Includes critical
reduction in tissue perfusion.
Sepsis- life threatening complication of a dysregulated response to infection
Diagnosis- blood test for evidence of infection, clotting problems, liver and kidney
function, o2, electorlyte
2) Describe the SIRS criteria by listing the four signs of the systemic inflammatory
response syndrome.
Tachycardia (HR > 90 beats per min), tachypnea (RR > 20 breaths per min), temp ( above
38 C or below 36 C), and leukocytosis or leukopenia (WBC > 1200/mm3 or <
4000/mm3)
3) Describe the difference between a diagnosis of SIRS and a diagnosis of sepsis
Sepsis: Sepsis is the body’s extreme response to an infection. It is a life-threatening
medical emergency. Sepsis happens when an infection you already have triggers a chain
reaction throughout your body. Sepsis can lead to death if not treated in time
