Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Recognize sepsis; start antibiotics and fluids; measure lactate and obtain cultures.
- If hypotensive after fluids → start norepinephrine; add vasopressors/steroids if refractory.
- Early source control (drainage, debridement, device removal); reassess frequently.
Clinical Synopsis & Reasoning
Apply Surviving Sepsis bundles: obtain cultures, start broad antibiotics, and give 30 mL/kg balanced crystalloids for hypotension or lactate ≥4. Use norepinephrine as first‑line vasopressor to target MAP ≥65; add vasopressin or epinephrine as needed. Achieve early source control.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|
| Blood cultures before antibiotics (do not delay) | Microbiology | Enable de‑escalation | — |
| Lactate trend and perfusion assessment | Severity | Resuscitation target | — |
| Source identification (imaging, bedside US) | Etiology | Guides source control | — |
High-Risk & Disposition Triggers
| Trigger | Why it matters | Action |
|---|
| MAP <65 despite fluids or lactate ≥4 | Septic shock | Start vasopressors; ICU |
| Respiratory failure or AMS | Organ dysfunction | Early airway; close monitoring |
| Immunosuppression or neutropenia | High risk | Early broad coverage; ID consult |
| Suspected source requiring control | Ongoing sepsis | Urgent source control (OR/IR) |
| Persistent hypotension after >30 mL/kg | Refractory shock | Add vasopressors/inotropes; steroids per guideline |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|
| Piperacillin‑tazobactam/cefepime + vancomycin (local antibiogram) | Empiric antibiotics | Hours | Time‑critical | De‑escalate with cultures |
| Balanced crystalloids 30 mL/kg for hypotension/lactate ≥4 | Resuscitation | Hours | Restore perfusion | Avoid overload |
| Norepinephrine first‑line; add vasopressin 0.03 U/min; consider epinephrine | Vasopressors | Minutes | Maintain MAP ≥65 | Arterial line preferred |
| Hydrocortisone 200 mg/day (refractory shock) | Adjunct | Hours | Wean pressors | — |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- Surviving Sepsis Campaign guidelines — Link