Septic shock occurs as a result of severe, life-threatening infections. It can be a result of an infection with a bacteria, virus, or fungus. It can affect anyone at any age, but more commonly affects the very young, the very old, and patients with a compromised immune system. Survival depends on early recognition of the condition and aggressive treatment with intravenous fluids and antibiotics. An approach to septic shock introduced by Dr. Emmanuel Rivers in 2001, known as early goal directed therapy, presents a screening and treatment protocol that is now commonly used. It screens for patients with hypotension, a suspected infection, and a serum lactate level greater than four. These patients are initially treated with an aggressive intravenous fluid bolus and broad spectrum antibiotics. If after this bolus the patient is persistently hypotensive or if the lactate is still greater than four, then a central line is placed with central venous pressure monitoring initiated. Fluids are infused until the CVP reads between eight and twelve mm of Hg. Vasopressors are initiated to maintain blood pressure and improve perfusion. While some recent studies have questioned the value of the entire package of early goal directed therapy, the lessons imparted related to screening and aggressive initial therapy have made a concrete impact on improving sepsis care around the world.
ADULT RESUSCITATION Adult resuscitation follows the principles and protocols outlined by the ACLS guideline, known as advanced cardiac life support. This guideline outlines a sequence of algorithms to treat cardiac arrest, bradycardia, tachycardia, stroke, and other critical presentations. The protocol discusses chest compressions, oxygen ventilation, cardioactive medications like epinephrine, and the use of a manual electrical defibrillator. Unlike the basic life support, or BLS course, which is open to all types of students including members of the public, ACLS is only available to health providers. These include physicians, pharmacists, nurses, dentists, respiratory therapists, paramedics, physician assistants, and nurse practitioners. The ACLS course requires that students are able and qualified to intubate patients, start intravenous lines, read an electrocardiogram, and 10
