Shock can be thought of as an imbalance of supply and demand of oxygen. It is a circulatory failure, where impaired tissue perfusion is insufficient for the needs of the body.
This patient has warm extremities and low JVP, from peripheral vasodilation. This leads us to identify the shock as a distributive cause. The history of a recent illness in an immunocompromised patient points towards sepsis as the cause of distributive shock.
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.
SIRS may be considered to aid in identifying patients with possible infection:
2 or more of…
- Temp <36 or >38
- HR > 90
- RR > 20 or PaCO2 <32
- WBC <4 or > 12 or > 10% immature bands
qSOFA may be considered to screen for patients likely to have sepsis:
2 or more of…
- Hypotension (sBP 100 or less)
- Altered mental status
- Tachpynea (RR 22 or more)
Image from University of Calgary Blackbook (http://blackbook.ucalgary.ca/cardiovascular/shock/)
