Septic Sam — Distributive Shock
Warm flushed skin early, then BP bottoms out
Sam throws a party in every blood vessel he owns — everything dilates, everything opens up. For an hour he's warm and pink and looks fine. Then the party drains the tank and his pressure falls through the floor.
Sam looks deceptively good early: warm, flushed skin and bounding pulses from massive vasodilation. Then MAP crashes, lactate climbs and urine output drops. Cultures before antibiotics, aggressive fluids, then vasopressors if MAP stays under 65.
Read Septic Sam's full story →The story arc
The setup
A urinary tract infection in an 78-year-old goes untreated for a week; the only complaint is that he seems confused.
The turn
He arrives warm, pink and bounding — heart rate 118, temperature 38.9°C, blood pressure still 'okay.'
The crisis
Lactate is 4.6, MAP falls to 58 after two liters of fluid, and urine output stops.
The save
Cultures were drawn before the first antibiotic, 30 mL/kg of crystalloid went in, and norepinephrine is now titrated to a MAP of 65.
NCLEX study section — Distributive Shock
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Cardiovascular
Take this chapter into practice questions on the same topic.