ABCs: airway and breathing
Airway, breathing and circulation remain
the fundamental principles of resuscitation
also in patients with septic shock. Priority is
given to the airway, which is immediately
assessed and secured, if necessary. High flow
oxygen via facemask or nasal canulae should
be given, even in the absence of respiratory
distress or hypoxemia.
Aggressive airway management and ventilation
should be considered in any patient not
responding to fluid resuscitation and peripherally
administered inotropes. Indeed, early intubation
and mechanical ventilation may support
cardiac output (CO) by reducing the work of
breathing, reduce oxygen consumption by
sedation, facilitate procedures for establishing
invasive hemodynamic monitoring, provide
airway protection.11
Vascular access
Rapid attainment of a vascular access is of
critical importance, possibly through the placement
of two large bore peripheral venous
catheters. If these catheters cannot be
obtained easily, the intraosseous route or a
central venous catheter should be considered,
depending upon the available expertise.
If at all possible, blood samples should be
taken for haematological parameters, urea and
electrolytes, blood glucose, culture and crossmatch.
At this point empirical antibiotic therapy
should be started intravenously