Septic shock is a clinical syndrome caused by various pathogenic bacteria and their toxins invading the human body, leading to microcirculatory dysfunction and inadequate blood perfusion of tissue cells, resulting in acute dysfunction of vital organs. It often occurs in the context of acute infectious diseases such as toxic bacillary dysentery, fulminant meningococcal meningitis, hemorrhagic necrotizing enteritis, sepsis, severe pneumonia, and biliary tract infections. Clinically, it is characterized by pallor, cold extremities, mottled skin, reduced urine output, and decreased blood pressure. It is one of the common critical illnesses in pediatrics.

bubble_chart Clinical Manifestations

1. Complexion pale or lips, fingers, and toes cyanotic, with mottled skin.
2. Cold extremities, prolonged capillary refill time.
3. Thready and rapid pulse, decreased blood pressure or even unmeasurable, narrowed pulse pressure.
4. Decreased urine output.
5. Mental confusion, apathy, or unconsciousness.
6. Anorectal-to-toe temperature difference >6°C.

bubble_chart Auxiliary Examination

1. For early-stage, grade I shock, the examination primarily focuses on categories "A and B."
2. For advanced stage, severe, or refractory shock, the examination may include categories "A, B, and C."
3. Blood cultures, cerebrospinal fluid cultures, and stool cultures are best performed before administering antibiotics.
4. Blood electrolytes, stirred pulse blood qi aspect analysis, hematocrit, platelet count, coagulation time, urine specific gravity, and other items should be measured repeatedly based on changes in the patient's condition.

bubble_chart Diagnosis

1. There is a primary infectious disease.
2. The complexion is pale, with cyanosis in the extremities and mucous membranes, marbled skin changes, and cold extremities.
3. The pulse is rapid and thready, with a capillary refill time ≥2 seconds.
4. Urine output is reduced: Grade I shock—5–10 ml/hour in infants, 10–20 ml/hour in children; Grade III shock—less than 5 ml/hour in infants, less than 10 ml/hour in children.
5. Blood pressure drops to undetectable levels, with a pulse pressure <4Kpa（30mmHg），早期輕度休克血壓可正常。
6. Lethargy, confusion, and significantly increased respiratory rate.

bubble_chart Treatment Measures

Principles of Treatment

1. Expand blood volume and correct acidosis.
2. Relieve spasm of microcirculatory blood vessels.
3. Administer cardiac strengthening therapy.
4. Implement anti-infection measures.
5. Apply adrenal glucocorticoids.
6. Protect the function of vital organs, and prevent and treat cerebral edema, cardiac insufficiency, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and acute renal insufficiency.

1. For septic shock, select at least two antibiotics to which the bacteria are sensitive based on the primary disease, administer them intravenously, ensure adequate dosage, and complete the full course. If the pathogen is unclear, choose two broad-spectrum, highly effective bactericidal agents that cover both cocci and bacilli. Once the pathogen is identified, adjust medication according to drug sensitivity results.
1. Shock patients often exhibit varying degrees of reduced cardiac function. Cardiac strengthening drugs should be used during the initial rapid fluid infusion. In cases complicated by heart failure, control the infusion rate and total fluid volume appropriately, and limit the use of sodium-containing solutions and hypertonic dehydrating agents.
2. In fulminant meningococcal disease complicated by shock, disseminated intravascular coagulation (DIC) and hyperfibrinolysis often coexist. Treatment should not wait for laboratory results; instead, initiate therapy immediately based on clinical symptoms and signs. Heparin and 6-aminocaproic acid can be used simultaneously.
3. For shock complicated by acute renal failure, accurately calculate intake and output to maintain water and electrolyte balance. Use dopamine and 654-2 to improve renal microcirculation.
4. Naloxone, a morphine receptor antagonist, counteracts the effects of β-endorphins and reverses hypotension in shock. It often yields good results in refractory shock. When traditional shock treatments fail, naloxone should be administered promptly.

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Septic shock is a manifestation of severe progression in infectious diseases, with a critical condition and high mortality rate. Early detection and timely treatment are key to preventing shock. If a child exhibits symptoms such as lethargy, unconsciousness, cold extremities, profuse cold sweating, mottled skin, pale complexion, cyanotic lips, and rapid breathing, these are signs of critical illness, and the child should be rushed to the hospital for emergency care. Parents should actively cooperate with medical staff by providing as detailed a medical history as possible to facilitate rescue efforts.

bubble_chart Cure Criteria

1. Cure: The following conditions persist for more than 12 hours.
   1. Fully conscious and alert.
   2. Warm extremities, lips and nail beds turning pink, strong pulse.
   3. Urine output >30ml per hour.
   4. Central venous pressure (CVP) 0.58～1.18KPa (6～12 cmH2O).
   5. Normal blood pressure, pulse pressure >=4KPa (30mmHg).
2. Improvement: The above conditions show varying degrees of improvement but do not meet the cure criteria.
3. No cure: The above conditions show no improvement or continue to worsen.