الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Sepsis is a dynamic disease with a complex pathophysiology that has a varied and unspecific clinical presentation and affects a heterogeneous group of people. For these reasons, a simple definition is not feasible.
Sepsis nowadays is considered as syndrome noted by systemic inflammatory response syndrome (SIRS), in evidence of infection SIRS become sepsis. Severe sepsis, septic shock and Multiorgan dysfunction can easily complicate the condition and increase risk of morbidity and mortality.
Cold septic shock is defined as persistence of signs of shock despite fluid resuscitation in septic patient. Septic shock increases the risk of mortality significantly.
Clinical assessment of critically ill patients includes head to toe evaluation and assessment of vital signs. Blood pressure, heart rate and signs of perfusion remain a corner stone in monitoring of a shocked patient.
Infection disrupts the normally delicate inflammatory balance, resulting in hyperinflammation and immune suppression. This dysregulated immune response is associated with a failure to return to homeostasis and causes harm to the host, resulting in sepsis. Hypotension in septic shock results from the triad of vasodilatation, ―capillary leak,‖ and myocardial depression. Vasodilation is due to failure of smooth muscle to contract appropriately. The most common system dysfunction associated with sepsis is the cardiovascular system. Septic shock is really a composite of hypovolemic, cardiogenic, and distributive shock. Distributive shock is related to endothelial NO production that leads to excessive vasodilation. Cardiogenic shock may be related to mitochondrial death with subsequent myocardial dysfunction.
Historically, dopamine has been favored as the vasopressor of choice for pediatric sepsis. However, in light of the 2016 Surviving Sepsis Campaign geared toward adults and the 2017 American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock, epinephrine became the first choice in pediatric septic shock.