1Mean arteriole pressure (MAP) formula
1/3 (SBP) + 2/3 (DBP)
2Blood pressure signs of shock
SBP <90, or MAP <70
We want to restore at least 65 MAP in septic shock patients
3First treatment for sepsis
30ml/kg of crystalloids for hypotension or lactate of >4mmol/L within 3 hours of sepsis identification
4Preferred fluids?
Crystalloids, NS or LR, LR is not the preferred choice
5What to do if fluids aren't enough?
Start vasopressors
6First choice vasopressor for sepsis
Norepinephrine (A1 and B1, raises vascular resistance and cardiac output)
7Second line vasopressor for sepsis
Add vasopressin or epinephrine (vasopressin increases vascular resistance, epinephrine is similar to norepi but also stimulates B2 which lessens vascular resistance)
8When to use dopamine?
As an alternative to norepinephrine in specific populations (higher risk of tachyarrythmia so use in pts with bradycardia potentially)
9When to use dobutamine?
If fluid and primary vasopressor therapy has failed
10When to use steroids in sepsis?
When patient is using vasopressors
11Steroid dose in sepsis
IV hydrocortisone 200mg/day