>> To understand the labs of septic shock,
let's first go ahead and recall what septic shock is.
So really briefly, remember,
septic shock is infected material that you see
in blood vessels, and white blood cells mount a response
to this septic material, and in mounting a response,
they release all these different immune molecules
that can cause damage to blood vessels
and increase blood vessel diameter, and the permeability
of blood vessels, and so on and so forth.
So what's the first thing you think you would want to do
in a patient who might have shock?
Well, first of all, we want to diagnose it, right?
So what can we do to diagnose shock?
Well, we have a couple of lab tests that we can use.
So the first thing you want to do is check,
you know, what's going on?
A patient comes in who has fevers, chills,
they're sweating, they're very flushed, and you notice
that their blood pressure is dropping.
So you're thinking, maybe septic shock.
So the first thing you want to do,
aside from checking your temperature
and checking their vital signs is you want to check, you know,
maybe they have an infection in their blood.
Maybe there's infective material in their blood.
So you can do that now by getting blood cultures.
Because you want to grow out whatever is in the blood,
and see if it's a fungus or a bacteria or a virus.
So blood cultures will allow you to figure
out what organism is in the bloodstream.
Next, you should probably figure out how severe the shock is,
and if in fact it is shock.
You know, are the organs damaged, or what's going on?
So you'll get values such as lactic acid or serum lactate,
and serum lactate is important
because it shows you tissue perfusion.
When cells of the body are no longer getting oxygen,
so these little orange boxes are cells,
when these guys are no longer getting oxygen,
they have to resort to another way to produce energy,
and that other way is anaerobic metabolism.
Metabolism without oxygen.
And a byproduct of that is lactate or lactic acid.
So measuring the levels of serum lactate will tell you just how
oxygen starved these cells are.
Next, you could also get an ABG, or arterial blood gas.
That will tell you how much oxygen is in the blood,
and it will also tell you things like the carbon dioxide,
different blood gases.
And then you'll get some other lab tests
that are maybe organ specific.
So for example, you might want to get a BUN or a creatinine.
And these are specific tests for the kidney.
So I'm only going to write down these tests for the kidney,
but you might want to get tests for other organs as well.
Now, the lab values for the kidney are especially important
because if the kidneys are deprived of oxygen
for just a little while, they cab actually be damaged.
So they're more readily injured by lack of oxygen.
So these are good labs to get.
Now, once all these labs are in the works,
the next logical step is to immediately treat this patient.
And treatment is associated with mortality.
The sooner the patient is treated, the more likely it is
that they will survive.
So they will have decreased mortality
if they're treated more quickly.
And the treatment usually starts
with just very broad spectrum antibiotics.
Broad spectrum antibiotics.
Now, why broad spectrum?
Well, when you first treat sepsis,
you will have drawn a blood culture,
but you won't have the results back yet, so you have to start
with an antibiotic that can treat many different types
of infections-- gram positive, gram negative,
many different types of bacteria.
And if the patient does not really get better
with broad-spectrum antibiotics,
use of anti-fungals may also be indicated,
because there may be a fungal infection.
But usually you start here, broad-spectrum antibiotics,
and then you'll check the blood cultures afterwards,
and once those cultures return, the patient can e switched
to a more tailored antibiotic therapy to provide an antibiotic
or anti-microbial that the organisms is susceptible to.
Now, remember, not only is there an infection going on,
but as a byproduct of this infection,
the patient has a drop in blood pressure,
so treatment will also include IV fluids
to restore blood pressure as well
as a medication called "pressors."
And what pressors do is they help squeeze down blood vessels
to allow an increase in systemic vascular resistance,
or resistance of blood vessels,
which helps restore the blood pressure as well.
So both of these will increase blood pressure.
So treatment will likely take days to weeks,
and in the meantime, while the patient is recovering,
what do you think the next logical step is?
You know, the patient has been diagnosed with septic shock,
they're being treated for it.
So the next step is really to see how the progress
of the patient is, what's the progress of the infection?
To check the progress, you know, you might continue
to get lactate, ABG, BUN and creatinine
to monitor the patient, but you can also get other labs,
such as a CRP or an ESR.
Now CRP stands for C-reactive protein, and ESR stands
for erythrocyte sedimentation rate.
Really, the names of these are somewhat inconsequential.
The main idea here is you can track inflammation.
So these allow you to track inflammation,
and when a patient is first diagnosed with septic shock,
these values are going to be very elevated,
possibly up around 100, each of these.
And just to give you an idea the normal values, the normal value
of CRP should be less than 1 mg per deciliter,
and the normal ESR really depends on age,
but it will be probably below 20
or maybe 25 millimeters per hour.
That's the units of ESR, erythrocyte sedimentation rate.
And so CRP and ESR, as I was saying,
may be drastically elevated.
So resolution of septic shock will show these values starting
to go back down to normal.
Searching for a down-trend of these elevated lab values.
So really, that's it with septic shock.
And it all makes sense based off of what is going on.
Infective material in the bloodstream.
Let me make a couple final points.
You always want to start
with blood cultures before you do antibiotic therapy.
This is very important, so that the organism
in the patient's bloodstream can be discovered.
If broad-spectrum antibiotics are started before blood
cultures are obtained,
there will be antibiotics in the blood.
So when a lab technician goes to culture it,
those antibiotics might interfere with the growth
of the blood cultures.
So always-- blood cultures first, and then antibiotics.
But also another great thing
to know is these should not be delayed.
Because remember delay in treatment can lead
to increased mortality.
And last of all, many hospitals,
we might hear the term two large-bore IV lines
for IV fluid treatment.
Essentially that's establishing two lines in either arm,
in which fluids can get to the patient,
and they'll be called large-bore because they'll be very large
in diameter, these tubes will have a very large diameter,
and this allows for fluid, IV fluid,
to get to the patient quicker.
So that blood pressure can be increased very quickly.
So remember the steps-- diagnosis, treatment,
and then tracking progression of septic shock.