Below, you will find summary information on anaphylactic shock. The issue is described in detail in the Oxford Handbook of Critical Care (see below). 

Septic shock

Definition:

• Sepsis is defined as a new, potentially life-threatening organ dysfunction due to a dysregulated host response to infection.
• Septic shock is sepsis with persistent hypotension, requiring vasopressor administration to maintain mean arterial blood pressure above 65 torr with adequate fluid resuscitation and having an elevated lactate above 2 mmol/l.
  

Symptoms:

• A: airway patency may be compromised in case of consciousness alteration.
• B: tachypnea, low oxygen saturation, in case of pneumonia - auditory findings (crackles and whistles mostly unilaterally).
• C: tachycardia, hypotension, prolonged capillary refill time, skin mottling, oliguria/anuria - urine may be cloudy in urosepsis.
• D: consciousness alteration, confusion, in case of neuroinfection, also headache, photophobia, meningeal symptoms.
• E: fever, in case of acute abdomen- signs of peritoneal irritation, vomiting, diarrhoea.
  • leg ulcers, decubitus, petechiae (meningococcal sepsis), or infected surgical wounds.
  • lines - signs of inflammation.

Diagnostics:

1.) ABCDE approach - new organ dysfunction identification.

2.) Searching for the source of infection: blood cultures, chest X-ray, sputum, abdominal ultrasound or CT scan, urine sampling for microbiology and biochemical examination, invasive accesses checking, wound and decubitus infections; according to symptoms, cerebrospinal fluid sampling...

3.) Collection of blood cultures or other microbiology material, preferably before antibiotics therapy (urine, sputum, fluid from purulent collection...). Only collect material before antibiotics that will not cause a delay in their administration.

4.) The sepsis/septic shock diagnosis may be supported by an elevated body temperature or lab tests with signs of inflammation: elevated CRP, procalcitonin, leukocytes...

5.) We measure lactate in patients with persistent hypotension despite adequate fluid resuscitation.

Therapy:

1.) Broad-spectrum antimicrobial therapy after blood cultures and other material collection. The material collection can not cause a delay in their administration.

2.) Fluid resuscitation, as part of symptomatic therapy, primary bolus of 500 ml of balanced crystalloids, could be repeated according to the response of vital functions.

3.) Early vasopressor administration as part of symptomatic therapy - the drug of choice is Noradrenaline. If the patient persists hypotensive despite adequate fluid therapy (MAP below 65 torr), we initiate continuous infusion of Noradrenaline, dose titration to target MAP above 65 torr. 

4.) ABCDE approach and applying the "treat as you go" principle.

5.) Eradication the source of the infection.