Septic Shock

Legacy Content

This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Shock, septic

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Category/Organ System:	Category: Cardiovascular Problems (old)
Type:	[[:Category: Medical Problem (old)]][[Category: Medical Problem (old)]]
Main Diagnosis:	Septic Shock
Sub Diagnosis:	SEPTIC SHOCK
Diagnosis Code:	Septic Shock - 4400
Comorbid Diagnosis:	No
Charlson Comorbid coding (pre ICD10):	0
Program:	Critical Care and Medicine
Status:	Currently Collected

Mutually exclusive with Severe Sepsis

Also see Septicemia definition.

See QA Septic Shock audit started September 2009.

Definition

(1) Blood pressure (BP) criteria

• If at least one of the following is present, code Septic Shock:
  • systolic BP < 90 mmHg for > 30 minutes and not responding to fluid resuscitation or
  • mean (m)BP < 65 mmHg (is this an "and" to the next line?)
  • BP drop of > 40 mmHg from baseline for > 30 min or
  • use of vasopressor to maintain systolic BP >= 90 mmHg in the absence of other causes of shock, e.g.:
    • no hypovolemia
    • no MI
    • no pulmonary embolus
• If none of the BP criteria are met:
  • see Severe Sepsis

(2) Other Criteria

Plus at least two of:

• temperature > 38.5 C
• HR > 90
• RR > 20

(3) Organ Failure Criteria

Plus at least one of (organ failure):

• Neuro changes: GCS < 14
• Lactic Acidosis: at least one of
  • LA > 2.0 or
  • PH < 7.30 or
  • BE < 10
• Oliguria: at least one of
  • urine < 0.5 cc/kg/hr or
  • urine output < 30 ml / hr or
  • serum creatinine increase > 40 uM from baseline
• Hypoxia: at least one of
  • PaO2 < 75 on RA or
  • PaO2 / FiO2 ratio <280 (not valid due to pneumonia)
• Coagulopathy: drop in platelets > 25% from baseline plus at least one of
  • > 25% PT or
  • > 25% PTT or
  • NR >1.5

Notes

• a positive culture is not required for septic shock
• you can use septic shock to code distributive shock unless it can be coded more accurately:
  • causes for distributive shock that should not be coded as septic shock are:
    • Anaphylactic ShockAnaphylactic shock - Caused by a severe anaphylactic reaction to an allergen, antigen, drug or foreign protein causing the release of histamine which causes widespread vasodilation. Leading to hypotension and increase capillary permeability.
    • Neurogenic or Spinal shock is the rarest form of shock. It is caused by trauma to the spinal cord resulting in the sudden loss of autonomic and motor reflexes below the injury level. Without stimulation by sympathetic nervous system the vessel walls relax uncontrolled, resulting in a sudden decrease in peripheral vascular resistance, leading to vasodilation and hypotension. (Source: wikipedia). In this case, the only code we have is 528: Spinal Shock

Data Integrity Rules

Septic shock (44-00) is mutually exclusive with 45-00 Severe Sepsis.