Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets (hemodynamic, neurologic, respiratory) and reassess frequently.
- Plan definitive source control or reperfusion when indicated; document follow‑up and patient education.
Algorithm
- Recognize sepsis; start Hour-1 bundle: lactate, blood cultures, broad antibiotics, fluids.
- If hypotension or lactate ≥4 → 30 mL/kg crystalloid; reassess hemodynamics.
- Start norepinephrine via central/peripheral with monitoring; target MAP ≥65.
- Add vasopressin ± epinephrine for refractory shock; consider hydrocortisone.
- Pursue source control urgently; de-escalate antibiotics based on cultures and clinical course.
Clinical Synopsis & Reasoning
Early recognition and treatment with cultures, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension or lactate ≥4, and norepinephrine as first-line vasopressor to MAP ≥65; add vasopressin and corticosteroids for refractory shock.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced or 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 |
|---|---|---|---|
| Lactate (serial) | Severity/response | Elevated, down-trending with resuscitation | Guide therapy |
| Cultures before antibiotics | Source ID | Positive in many | Do not delay antibiotics >45 min |
| Source imaging | Localize infection | Abscess, pneumonia, obstruction | Plan source control |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Crystalloids 30 mL/kg | Volume expansion | Immediate | Initial resuscitation | Adjust for HF/ESRD |
| Norepinephrine | α1/β agonist | Minutes | First-line vasopressor | Titrate to MAP ≥65 |
| Vasopressin 0.03 U/min | Vasopressor | Minutes | Add-on to reduce NE dose | Ischemia risk |
| Hydrocortisone 200 mg/day | Glucocorticoid | Hours | Refractory shock | Hyperglycemia |
| Broad-spectrum antibiotics (early) | Antimicrobials | Hours | Time-sensitive outcome benefit | De-escalate by culture |
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 (2021) — Link