 Hi, welcome to nursing school explained in this video on sepsis and septic shock. So first of all, let's look into this here. Sepsis usually occurs from a local infection that can occur anywhere in the body that spreads into the bloodstream. And I written down here those can be gram positive as well as gram negative bacteria, but also fungi can be the offensive organism. Most of the time, the source originates from either the respiratory or the urinary symptom. So this could be a common cough and cold that turns into an ammonia that turns the patient septic or maybe a UTI or a kidney infection that spreads from the urinary tract into the bloodstream. So let's look at the pathophysiology. Once the bacteria spread from the localized area into the bloodstream, the bacteria release toxins and that triggers an inflammatory response and recall from physiology that there are a lot of different inflammatory markers or inflammatory cells that come to the aid in the immune system. And these are cytokines and look-ins tumor necrosis factor, as well as platelet activation factor. All this immune response causes an increase in the vascular as well as capillary permeability, meaning that now the blood vessels get dilated and as the blood vessels themselves open up, fluid leaks out of the blood vessels causes massive vasodilation as well as thrombosis because we have the platelets that have been activated. Then all these mechanisms cause further inflammatory response and now we have more of the cytokines, interleukins, TNF and platelet activation factor responding to the site and now because we have these platelets coagulation occurs. So then now we have the sluggish blood flow because the platelets are aggregating and the fluid is leaking out of the blood vessels which leads to massive hypotension. When there is low blood pressure certain organs are at risk or are not getting perfused leading to tissue hypoxia and then acidosis follows and so patients who are septic many times will be in metabolic acidosis.