Septic shock: principles of management in the emergency department

Bacteremia is a potentially serious event which must be recognized early and treated aggressively to prevent progression to septicemia and septic shock. The pathophysiology of septicemia and shock includes inadequate tissue perfusion and oxygenation. Expansion of intravascular volume and pharmacologic cardiovascular support are designed to minimize resulting end-organ injury. Initial antibiotic therapy must be individualized and should include an agent or agents active against the common pathogens encountered in the specific clinical setting. Once the causative organism is isolated, therapy is targeted more narrowly. Despite the availability of a variety of newer antibiotics, the morbidity and mortality of septicemia and septic shock remain unacceptably high. Development of new pharmacologic agents active against the mediators of shock may offer future promise.