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Things to Consider for Persistent or Worsening Septic Shock
- Septic shock is one of the most common critical illnesses in emergency medicine and critical care.
- Norepinephrine is recommended as the initial vasopressor of choice for patients with septic shock, with vasopressin or epinephrine commonly added as a second vasopressor for patients with refractory shock.
- While vasopressors are being added and titrated, it is important to consider additional diagnoses in patients with worsening or persistent septic shock. Some of these diagnoses include:
- Undetected infection that requires emergent source control
- Concomitant causes of shock: cardiogenic, PE, abdominal compartment syndrome, tamponade, adrenal insufficiency
- Severe acidosis
- MAP underestimation by a radial arterial line
References
Teja B, et al. How we escalate vasopressor and corticosteroid therapy in patients with septic shock. Chest. 2023; 163:567-74.