Septic Shock with Multiple Organ Dysfunction Syndrome: A Case Report

  1. Marilakshmi Nurse Educator, Kauvery Hospital, Tirunelveli

Background

Sepsis is a life-threatening organ dysfunction that results from the body’s response to infection. It requires prompt recognition, appropriate antibiotics, careful hemodynamic support, and control of the source of infection. With the trend in management moving away from protocol-based care in favor of appropriate usual care, an understanding of sepsis physiology and best practice guidelines is critical.

Sepsis affects 750,000 patients each year in the United States and is the leading cause of death in critically ill patients, killing more than 210,000 people every year. About 15% of patients with sepsis go into septic shock, which accounts for about 10% of admissions to intensive care units (ICUs) and has a death rate of more than 50%.

The incidence of sepsis doubled in the United States between 2000 and 2008, possibly owing to more chronic diseases in the aging population, along with the rise of antibiotic resistance and the increased use of invasive procedures, immunosuppressive drugs, and chemotherapy.

Multiple organ failure is also known as multiple system organ dysfunction, sepsis, septic shock, shock and systemic inflammatory response syndrome. Outcomes prospectively defined were death and physiological reversal of end organ failure. Multiple organ dysfunction/failure (MODS) is the most common cause for death in intensive care units. The recognition of this syndrome in the last 30 years may be due to advances in early resuscitation unmasking these delayed sequels in those that would have died previously. Multiple organ dysfunction occurs after shock of varied etiologies and may be the result of unbridled systemic inflammation. As yet, therapy directed to prevent or improve MODS has not dramatically altered outcomes.

Case Presentation

A 34-year-old patient was referred to the hospital as a case of left leg cellulitis with septic shock and development of respiratory distress. The patient was apparently normal till 2021. Then he developed pain and swelling in both knees which the doctor diagnosed as migratory polyarthritis. He took treatment at an outside hospital for the same; he also took medicines for infertility from the Siddha system.

He came to the hospital with complaints of respiratory distress, cellulitis and more pus collection in the wound. Due to respiratory distress he was intubated and a CVC line was put as per protocols. After relieving of respiratory distress extubation was done as per protocol.

Examination

  1. CVS: S1, S2 present
  2. RS: Bilateral air entry verifies
  3. P/A: soft, non-tender.
  4. CNS: NFND
  5. SAO2: 98%
  6. BP: 130/70
  7. HR: 110 beats/mts
  8. RR: 49 breath/mts
  9. Temp: 100°F
  10. Patient tachypenic at rest, febrile.

Provisional diagnosis

  1. Septic shock with MODS.
  2. Bilateral acute inflammatory Sacrolitis
  3. Left leg cellulitis with septic arthritis.
  4. Migratory Polyarthritis.

Investigation

Echo-IVC-1.5 cm, EF-64%

Trivial MR

X-ray report

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ECG report

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Rt Axis deviation, R in aVR and V1, Clock Wise Rotation

USG abdomen report

Hepatomegaly, diffuse fatty changes and mild splenomegaly

ECHO report

  1. IVC-1.5 cm, EF-64%
  2. Trivial MR
  3. Pulmonary thromboembolism.
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CT Thorax Report

Bilateral multifocal consolidation

Cryptogenic organizing pneumonia

Treatment

S.No  Drug Name  Strength      Frequency    Route of
  admin		   Relationship  

    with meal

   Days  
M A E N
1 Tab. Pulmoclear 1 0 0 1 Oral After food 1 Week
2 Tab. Vibact 1 0 0 1 Oral After food 1 Week
3 Tab. Menobol 1 0 0 1 Oral After food 1 Week
4 Tab. Becadexamine 1 0 0 1 Oral After food 1 Week
5 Tab. Ivabrad 5MG 1/2 0 0 1/2 Oral After food 1 Week
6 Tab. Lonazep 0.5MG 0 0 0 1 Oral After food 1 Week
7 Tab. Hisone 5mg 1 0 0 0 Oral After food 1 Week
8 Tab. Cipro 500MG 1 0 0 1 Oral After food 1 Week
9 Tab. Rablet 20MG 1 0 0 0 Oral Before food 1 Week
10 Tab. Glycinorm 40MG 0 1/2 0 0 Oral After food 1 Week
11 Syp. Kcl 30ML 1 1 1 1 Oral After food 1 Week
12 Syp. Betonin 2tsp 1 0    0 1 Oral After food 1 Week
13 Liq. Paraffin L/A
14 Tab. Quitipin 25MG 0 0 1 0 Oral After food 1 Week

Diet advice 

Normal diet

Nursing management                      

  1. The initial step involves promptly identifying and isolating the source of infection through various methods such as blood cultures or diagnostic imaging, and appropriate antimicrobial therapy. Implementing strict infection control practices in healthcare settings plays a vital role in reducing the risk of hospital-acquired infections
  2. Assess the client for a possible source of infection (e.g., burning urination, localized abdominal pain, burns, open wounds or cellulitis, presence of invasive catheters, or lines)
  3. Septic shock is defined by persisting hypotension requiring vasopressors to maintain a mean arterial pressure. Prompt recognition and intervention, including fluid resuscitation, vasopressor therapy, and antibiotic administration, are essential to prevent or treat septic shock
  4. Promote optimal breathing patterns, including deep breathing exercises and positioning
  5. Fluid resuscitation to increase perfusion
  6. Support care and monitoring including Multi-organ support
  7. Mechanical or non-invasive ventilation
  8. Maintaining fluid homeostasis
  9. Renal replacement therapy

Outcome

On discharge, patient was hemodynamically stable and patient came for grafting procedure on 07.08.23.

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Ms. K. Marilakshmi

Nurse Educator

Nightingale Journals

Kauvery Hospital
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