Documentation Tip of the Week: Shock v. Septic Shock

Posted on Wed, Jul 29, 2015
Documentation Tip of the Week: Shock v. Septic Shock

Our weekly feature of documentation tips for clinicians.


  • Defined as a life-threatening, generalized maldistribution of blood flow resulting in failure to deliver and/or utilize adequate amounts of oxygen, leading to tissue dysoxia
  • Hypotension (SBP < 90, SBP decrease of 40 mmHg from baseline, or mean arterial pressure (MAP <65), while commonly present, should NOT be required to define shock
  • In the absence of hypotension, when shock is suggested by history and physical examination, we recommend that a marker of inadequate perfusion be measured (decreased ScvO2, SvO2, increased blood lactate, increased base deficit, perfusion-related low pH)
Septic Shock: Sepsis with Hypotension
  • If hypotension resolves after recommended 30 cc/kg fluid bolus then diagnose severe sepsis
  • If hypotension persists after recommended 30 cc/kg fluid bolus then diagnose septic shock and begin Levophed (preferred pressor)
  • If Lactic acid > 4.0 with sepsis then diagnose septic shock and treat as septic shock Reference


Timothy Brundage, MD, is a hospitalist for EmCare at St. Petersburg General Hospital in St. Petersburg, Fla. Dr. Brundage earned his bachelor’s degree in chemistry and molecular biology at the University of Michigan, his medical degree at the Wayne State University School of Medicine and completed his residency in internal medicine at the University of South Florida College of Medicine. Subscribe to Dr. Brundage’s weekly documentation tips or ask him about specific documentation issues by emailing him at

CAE Healthcare
FYI: The Lucina simulator trains health workers in septicshock diagnosis & treatment.
8/3/2015 2:29:48 PM