Clinicians should understand the importance of prompt administration of intravenous fluids and vasoactive medications aimed at restoring adequate circulation, and the limitations of protocol-based therapy, as guided by recent evidence. The prompt diagnosis of septic shock begins with obtainment of medical history and performance of a physical examination for signs and symptoms of infection and may require focused ultrasonography to recognize more complex physiologic manifestations of shock. Hydroxyethyl starch is no longer recommended, and debate continues about the role of various crystalloid solutions and albumin. Early diagnosis and treatment are necessary due to high mortality rates 1. In septic shock, 3 randomized clinical trials demonstrate that protocolized care offers little advantage compared with management without a protocol. Sepsis is quite important as it is seen in 10 of 1000 hospitalized patients and multiple organ dysfunction syndrome (MODS) develops in 30 of these patients mortality is observed in 20 of patients with sepsis and 6080 of patients with septic shock. Focused ultrasonography is recommended for the prompt recognition of complicating physiology (eg, hypovolemia or cardiogenic shock), while invasive hemodynamic monitoring is recommended only for select patients. OBSERVATIONS AND ADVANCES: In the setting of suspected or documented infection, septic shock is typically defined in a clinical setting by low systolic (≤90 mm Hg) or mean arterial blood pressure (≤65 mm Hg) accompanied by signs of hypoperfusion (eg, oliguria, hyperlactemia, poor peripheral perfusion, or altered mental status). Septic shock is a clinical emergency that occurs in more than 230,000 US patients each year.
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