Shock: Solution 10

Clinical Scenario 10

A 72 year old female is admitted complaining of weakness, sweating and dysuria. Her temperature is 39⁰C, pulse 130, BP 76/44, warm peripherally, lung fields: reduced air entry bilaterally, oliguria, Hb 16 g/dl, WCC 27, PO2 8.2, MSU gram -ve bacilli, >10⁵ organisms.

This woman has urosepsis, probably with gram negative organisms, leading to septic shock. She has a generalized vasodilated state and relative hypovolemia. She requires oxygen and airway control, aggressive volume loading, empiric antibiotics, source control and, if necessary, vasopressors.

Dx: distributive shock, due to sepsis, vasoplegia, relative hypotension.