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.
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 |
Signs of Poor Perfusion
| Sign | Implication |
|---|---|
| Prolonged capillary refill | Hypoperfusion |
| Cool extremities and weak pulses | Hypovolemia or vasoconstriction |
| Altered mental status | Shock |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Balanced crystalloids | Plasma volume expansion | Immediate | Initial resuscitation (e.g., 30 mL/kg) | Fluid overload; monitor oxygenation; ED use; pediatric dosing/contra nuances |
| Norepinephrine | α1-adrenergic agonist | Minutes | First-line vasopressor to target MAP ≥65 mmHg | Arrhythmia, ischemia; ED use; pediatric dosing/contra nuances |
| Broad empiric antibiotics | Bactericidal (varies) | Variable | Start within 1 hour; de-escalate to source | Allergy, resistance; ED use; pediatric dosing/contra nuances |
| Hydrocortisone (refractory shock) | Glucocorticoid | Hours | Adjunct in pressor-refractory septic shock | Hyperglycemia, infection risk; ED use; pediatric dosing/contra nuances |
| Vasopressin (adjunct) | V1 receptor agonist | Minutes | Catecholamine-sparing add-on in refractory shock | Ischemia at high dose; ED use; pediatric dosing/contra nuances |
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.
Notes
Use age specific blood pressure targets. Coordinate with pediatric ICU and follow Surviving Sepsis guidance.