Introduction Caused by decreased peripheral vascular resistance. Usually seen If delayed arrival to ER (several hours). Suspicious in patients with penetrating abdominal wounds with GI peritoneal contamination Presentation Presents like hypovolemic shock Patients can be afebrile initally Evaluation Filling Pressure(RA and PCWP) Cardiac Output Vascular resistance Septic shock Low Increased Low Cardiogenic High Low High Hypovolemic Low Low High Cardiac tamponade High Low High Papillary muscle rupture High Low High Treatment Intravenous volume resuscitation Broad spectrum IV antibiotics. Vassopressors in patients who still exhibit hypotension or organ hypoperfusion despite adequate volume resuscitation Norepinephrine is the first choice for septic shock to vasoconstrict peipheral arterioles. Side effects include digital ischemia (due to vasospasm), arrhythmias