Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
Sepsis represents dysregulated host response with life‑threatening organ dysfunction; prioritize rapid recognition using qSOFA/SOFA elements, attention to mentation, perfusion, and lactate trends. Clinically, integrate history for potential sources (pulmonary, urinary, abdominal, device‑related), examine for shock phenotypes, and obtain paired blood cultures without delaying therapy. Point‑of‑care ultrasound refines volume status and source hypotheses (e.g., pneumonia, cholecystitis, obstructive uropathy). Early identification of patients likely to decompensate guides ICU triage and invasive monitoring.
Treatment Strategy & Disposition
Initiate balanced crystalloid resuscitation targeting MAP ≥65 mmHg and improving capillary refill/lactate; start time‑appropriate empiric antibiotics within 60 min tailored to suspected source and local resistance. If hypotension persists after 30 mL/kg or sooner when indicated, begin norepinephrine and titrate to perfusion targets; add vasopressin for catecholamine‑sparing effects. Pursue urgent source control (drainage, device removal, debridement) and de‑escalate antimicrobials with culture data. Disposition hinges on shock and organ failure—ICU for vasopressors/respiratory support; otherwise step‑down/ward with protocolized reassessment.
Management Notes
Avoid routine lumbar puncture unless high suspicion or positive cultures. Stewardship reduces resistance and dysbiosis.
Epidemiology / Risk Factors
- Risk factors vary by condition and patient profile
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Baseline hematology | Abnormal counts | |
| BMP | Electrolytes/renal | Derangements |
When to Treat
| Scenario | Action |
|---|---|
| Chorioamnionitis or ill‑appearing infant | Start empiric antibiotics |
| Borderline risk, well infant | Enhanced observation ± labs |
| Term, low risk | Routine care |
| Preterm | Lower threshold for evaluation |
| Negative cultures at 36–48 h | Discontinue if well |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Broad empiric antibiotics | Bactericidal (varies) | Variable | Start within 1 hour; de-escalate to source | Allergy, resistance |
| Norepinephrine | α1-adrenergic agonist | Minutes | First-line vasopressor to target MAP ≥65 mmHg | Arrhythmia, ischemia |
| Vasopressin (adjunct) | V1 receptor agonist | Minutes | Catecholamine-sparing add-on in refractory shock | Ischemia at high dose |
| Hydrocortisone (refractory shock) | Glucocorticoid | Hours | Adjunct in pressor-refractory septic shock | Hyperglycemia, infection risk |
| Balanced crystalloids | Plasma volume expansion | Immediate | Initial resuscitation (e.g., 30 mL/kg) | Fluid overload; monitor oxygenation |
Prognosis / Complications
- Prognosis depends on severity, comorbidities, and timeliness of care
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
References
- AAP/CDC EOS Guidance — Link