Emergencies

Sepsis & Septic Shock

Cultures, lactate, broad-spectrum antibiotics, 30 mL/kg for hypoperfusion, and norepinephrine to MAP ≥ 65, all within the first hour.

Interactive pathway

Assess
Recognize sepsis
- Suspected infection + acute organ dysfunction
- qSOFA screen: RR ≥ 22, altered mentation, SBP ≤ 100 (screen, not diagnosis)
- Septic shock: vasopressors for MAP ≥ 65 AND lactate > 2 despite fluids
Action
Hour-1 bundle
- Measure lactate; remeasure if > 2 mmol/L
- Blood cultures before antibiotics (don't delay antibiotics)
- Broad-spectrum antibiotics within 1 h
- 30 mL/kg crystalloid for hypotension or lactate ≥ 4
- Vasopressors if hypotensive during or after fluids
Decision
MAP ≥ 65 after fluids?

Related EKGs