SAQ 466 – Infectious Diseases – meningococcal septic shock

Infectious Diseases – meningococcal septic shock.

a. Diagnosis

• Meningococcal septicaemia with septic shock.

b. Treatment priorities

• Early broad-spectrum IV antibiotics; ceftriaxone 2 g IV is appropriate in an adult.
• Aggressive shock resuscitation with reassessment after each intervention.
• Early ICU/critical care involvement and consideration of vasopressors, invasive monitoring and retrieval/transfer if needed.
• Consider adjuncts such as dexamethasone when meningococcal disease/meningitis is being treated according to local policy.

c. Hypotension

• Give further balanced crystalloid boluses, for example 500-1000 mL at a time, with frequent reassessment of fluid responsiveness and overload.
• Use bedside assessment of fluid status such as JVP, lung ultrasound, cardiac ultrasound, passive leg raise or central venous access when appropriate.
• Start noradrenaline if hypotension persists, for example 0.05-1 microgram/kg/min titrated to MAP/perfusion target.
• Correct reversible contributors such as hypoglycaemia, electrolyte abnormality, hypocalcaemia or hypoxia.
• Escalate to ICU and consider additional vasopressors/inotropes or ECMO in refractory shock.

d. Response variables

• Blood pressure/MAP and vasopressor dose.
• Heart rate and rhythm.
• Mental state and peripheral perfusion/capillary refill.
• Urine output.
• Lactate/base deficit and pH trend.
• Oxygenation, respiratory work and need for ventilatory support.
• Rash progression and temperature.

e. Sepsis trial

• ARISE, ProCESS or ProMISe are acceptable landmark sepsis trials.