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TABLE 10.5 EXAMPLE OF INITIAL ANTIMICROBIAL CHOICES IN SEPTIC SHOCK Patient history Antibiotic choices Previously healthy child Ceftriaxone and vancomycin with communityacquired infection Additional considerations Oseltamivir during influenza season Add clindamycin if toxin-mediated syndrome suspected Suspected intraabdominal source of infection Piperacillin/tazobactam and vancomycin OR Ceftriaxone, metronidazole, and vancomycin Immunocompromised Cefepime and vancomycin Consider antifungal patient, history of coverage for those Include gentamicin for cancer, chronic patients already on patients with history of medical conditions, broad-spectrum cancer/immunocompromise recent hospitalization antibiotics or resides in a longterm care facility, indwelling central line present Neonate Ampicillin and gentamicin Consider acyclovir Airway Management Supplemental oxygen should be provided to increase oxygen delivery while rapidly obtaining IV access, administering fluid, and initiating vasoactive infusions Use of a 100% nonrebreather mask provides the highest amount of noninvasive supplemental oxygen delivery Indications for intubation and mechanical ventilation are discussed below in the section on refractory shock If the patient has respiratory failure in addition to shock, extra caution needs to be taken during intubation and the transition from negative pressure to positive