A 79-year-old woman presents to the intensive care unit with septic shock caused by an Escherichia coli urinary tract infection. Pertinent vital signs on admission are as follows:  blood pressure 80/40 mm Hg, heart rate 155 beats/minute, respiratory rate 26 breaths/minute, and temperature 39.5°C.

On physical examination, the patient is weak, lethargic, and confused.

Her other laboratory values are as follows: sodium 155 mEq/L, potassium 3.6 mEq/L, serum creatinine 159 Mmol/L, and lactate 4.2 mmol/L (normal range 0.5-1).

a) Please identify the clinical symptoms and physiologic variables that indicate (i) systemic inflammatory response syndrome (“SIRS”) and (ii) shock syndrome present in this patient.

(6 marks) 

b) Describe the initial management of septic shock in this patient, including drugs and treatment goals. 

(6 marks) 

c) What are three other areas of general intensive care unit (“ICU”) care that need to be provided and/or monitored besides, for example, pain control and sedation?

(3 marks)