Pathophysiology of infection, inflammation response, and sepsis leading to septic shock (the cascade) is a major area of interest in the literature. Under normal circumstances, when a pathogen enters a human host and tissue damage occurs, the host initiates an inflammatory response to repair the tissue. The main types of pathogens include viruses, bacteria, and parasites (Porth & Matfin, 2009; Raghavan & Marik, 2006). Cellulitis is an example of an acute infection, which affects the skin and or subcutaneous tissue often in lower limbs. Cellulitis is caused by streptococcus pyogenes and staphylococcus aureus (multi-resistant bacteria) and is transmitted by direct contact, entering the body via broken skin such as ulcers and or following trauma. The presentation of cellulitis often includes pain (localised), erythema, fever and swelling. Infections such as cellulitis have a propensity to become systemic through distribution in the blood and lymph (Hadzovic-Cengic et al., 2012). The inflammation response to an infection involves the release of both pro and anti-inflammatory mediators. When excessive pro-inflammatory mediators such as cytokines are released they cause inflammation in a systemic manner that can cause sepsis or systemic inflammatory response syndrome (being the non-specific response to non-infectious cause) (Sagy, Al-Qaqaa, & Kim, 2013). Pro-inflammatory mediators also activate the complement system, which results in increased inflammation and upregulation of specific receptors that lead to cellular injury and apoptosis seen in severe sepsis and organ dysfunction (Ward, 2008). Organ dysfunction can occur in one or more organs such as the lungs, liver, kidneys and or heart and often results from a lack of perfusion. If unresolved, this leads to septic shock and multiple organ dysfunction syndrome (MODS) (Bledsoe, Porter, & Cherry, 2011). Septic shock is characteristic of total dysfunction of the normal immune response. Both the innate (non-specific early response) and adaptive (secondary response) immune systems are impacted by an excessive and or inadequate response that commonly presents as peripheral vasodilation, dysregulation of temperature, myocardial depression, intravascular volume depletion and hypotension despite intravenous fluids (IVF) (Baez et al., 2013; Nduka & Parrillo, 2009). Septic shock is a late clinical sign and indicates an immediate threat to life that should be treated aggressively as outlined in the next paragraph.
Best Practice Treatment Plans
Inflammation can quickly progress a systemic infection into septic shock and the prompt identification and timely treatment of reversible factors and underlying cause are important factors in improved outcome and decreased mortality (Baez et al., 2013; Band et al., 2011; Herlitz et al., 2012; Jones & Puskarich, 2014). Paramedics play an important role in the prevention of infection. Preventing infection is best achieved by hand washing according to the...