A condition that was formerly known by the popular name “blood
poisoning” is now called septic shock
by most clinicians. This refers to a bacterial infection widely disseminated to
many areas of the body, with the infection being borne through the blood from
one tissue to another and causing extensive damage. There are many varieties of
septic shock because of the many types of bacterial infections that can cause
it and because infection in different parts of the body produces different effects.
Septic shock is extremely
important to the clinician, because other than cardiogenic shock, septic shock
is the most frequent cause of shock-related death in the modern hospital.
Some of the typical causes of septic shock include the following:
1 Peritonitis caused by
spread of infection from the uterus and fallopian tubes, sometimes resulting
from instrumental abortion performed under unsterile conditions.
2. Peritonitis resulting
from rupture of the gastrointestinal system, sometimes caused by intestinal
disease and sometimes by wounds.
3. Generalized bodily
infection resulting from spread of a skin infection such as streptococcal or
4. Generalized gangrenous
infection resulting specifically from gas gangrene bacilli, spreading first
through peripheral tissues and finally by way of the blood to the internal
organs, especially the liver.
5. Infection spreading
into the blood from the kidney or urinary tract, often caused by colon bacilli.
Features of Septic Shock. Because of the multipletypes of septic shock, it is difficult to
categorize this condition. Some features often observed are:
1. High fever.
2. Often marked
vasodilation throughout the body, especially in the infected tissues.
3. High cardiac output in
perhaps half of patients, caused by arteriolar dilation in the infected tissues
and by high metabolic rate and vasodilation elsewhere in the body, resulting
from bacterial toxin stimulation of cellular metabolism and from high body
4. Sludging of the blood,
caused by red cell agglutination in response to degenerating tissues.
5. Development of
micro–blood clots in widespread areas of the body, a condition called disseminatedintravascular coagulation. Also,
this causes the blood clotting factors to be used up, so that hemorrhaging
occurs in many tissues, especially in the gut wall of the intestinal tract.
In early stages of septic shock, the patient usually does not have
signs of circulatory collapse but only signs of the bacterial infection. As the
infection becomes more severe, the circulatory system usually becomes involved
either because of direct extension of the infection or secondarily as a result
of toxins from the bacteria, with resultant loss of plasma into the infected
tissues through deteriorating blood capillary walls. There finally comes a
point at which deteriora-tion of the circulation becomes progressive in the
same way that progression occurs in all other types of shock. The end stages of
septic shock are not greatly differ-ent from the end stages of hemorrhagic
shock, even though the initiating factors are markedly different in the two