Sepsis & Septic Shock

Resuscitation Quick Ribbon (First 2 Minutes)

First-line Antibiotic Window:Within 60 minutes of ED arrival; obtain blood cultures x2 prior to infusion

Fluid Administration:30 mL/kg balanced crystalloid (Lactated Ringer's preferred over normal saline) in first 3h

Norepinephrine:0.05–0.5 mcg/kg/min (Levophed); start early via peripheral IV while fluids running

Vasopressin:0.03 units/min fixed dose (add when Norepinephrine reaches 0.25 mcg/kg/min)

Stress Dose Steroids:Hydrocortisone 200 mg/day (50 mg IV q6h) for septic shock refractory to vasopressors

Bottom-Line Clinical Pearl

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Administer broad-spectrum antibiotics within 1 hour of recognition. In septic shock (vasopressor requirement to maintain MAP >= 65 and serum lactate > 2 mmol/L despite fluids), do not wait to finish 30 mL/kg before starting Norepinephrine. Start peripheral Norepinephrine early to restore organ perfusion pressure, prevent fluid overload, and recruit microcirculation.

1. Sepsis-3 Definitions & Quick SOFA (qSOFA)

Condition	Clinical Definition	Key Criteria & Thresholds
Sepsis	Life-threatening organ dysfunction from infection	Increase in SOFA score >= 2 points caused by infection
Septic Shock	Subset of sepsis with profound circulatory & cellular abnormalities	Persistent hypotension requiring vasopressors for MAP >= 65 AND lactate > 2 mmol/L despite fluid resuscitation
qSOFA (Bedside)	Rapid bedside screening tool (>= 2 = high mortality risk)	1) Altered mentation (GCS < 15); 2) Systolic BP <= 100 mmHg; 3) Respiratory rate >= 22/min