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; obtain cultures and lactate; start antibiotics immediately.
- Administer 30 mL/kg crystalloid; reassess using dynamic markers and bedside echo.
- Start norepinephrine; add vasopressin; consider hydrocortisone for refractory shock.
- Achieve source control early (drainage/debridement); monitor perfusion and organ function; de-escalate antibiotics.
Clinical Synopsis & Reasoning
Suspected infection with hypotension requiring vasopressors to maintain MAP ≥65 mmHg or lactate ≥2 mmol/L despite fluids. Begin antibiotics within 1 hour, give initial 30 mL/kg crystalloid, use norepinephrine as first-line vasopressor (add vasopressin), target MAP and perfusion, and ensure 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 |
|---|
| Lactate, blood cultures ×2, and source imaging | Diagnosis/severity | Elevated lactate; pathogen ID | Do not delay antibiotics |
| Hemodynamics (arterial line), ScvO2/echo (selected) | Resuscitation endpoints | Perfusion targets | Guide therapy |
| Urine output and organ function labs | Monitoring | AKI, LFTs, coagulopathy | — |
High-Risk & Disposition Triggers
| Trigger | Why it matters | Action |
|---|
| Shock requiring vasopressors to maintain MAP ≥65 | High mortality | ICU; norepinephrine first-line; add vasopressin |
| Lactate ≥4 mmol/L or rising | Tissue hypoperfusion | Aggressive resuscitation; reassess q2–4 h |
| Suspected difficult source control | Ongoing infection | Early surgery/IR consult |
| Immunosuppression/pregnancy | Atypical course | Early ID/obstetric input |
| Oliguria or rising creatinine | AKI risk | Renal dose adjust; consider RRT |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|
| Broad-spectrum antibiotics (local protocol) | Antimicrobial | Minutes | Within 1 h of recognition | De-escalate with cultures |
| Crystalloid bolus 30 mL/kg then reassess | Fluid resuscitation | Minutes | Restore intravascular volume | Dynamic measures to guide |
| Norepinephrine infusion (add vasopressin; epinephrine/DBA as needed) | Vasopressors/inotropes | Minutes | Maintain MAP ≥65 | Steroids for refractory shock |
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