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Adult Sepsis and Septic Shock

Early recognition and management of sepsis and septic shock

Advanced
Medical
Updated
1/12/2024
Approved By
Medical Director
Version
2024.1
Elapsed
00:00

Indications

  • •Suspected infection with organ dysfunction
  • •qSOFA ≥2 (altered mental status, SBP ≤100, RR ≥22)
  • •Lactate ≥2 mmol/L
  • •Septic shock (hypotension despite adequate fluid resuscitation)

Contraindications

  • •Clear non-infectious cause of symptoms
  • •Comfort care only/hospice patient

Protocol Steps

Follow these steps in sequence for optimal patient care

1

Early Recognition

Identify sepsis using qSOFA criteria

CRITICAL
<15 minutes

Actions:

  • →Assess mental status (altered = +1)
  • →Check systolic BP (≤100 mmHg = +1)
  • →Measure respiratory rate (≥22/min = +1)
  • →Calculate qSOFA score (0-3)

Success Criteria:

  • qSOFA ≥2 suggests sepsis
  • Any single criterion warrants concern
2

Hour-1 Bundle

Complete initial sepsis bundle within 1 hour

CRITICAL
Within 1 hour

Actions:

  • →Measure lactate level
  • →Obtain blood cultures before antibiotics
  • →Administer broad-spectrum antibiotics
  • →Begin rapid fluid resuscitation (30 mL/kg crystalloid)
  • →Apply vasopressors if hypotensive during/after fluid resuscitation
3

Fluid Resuscitation

Aggressive fluid replacement for hypoperfusion

CRITICAL

Actions:

  • →Administer 30 mL/kg IV crystalloid rapidly
  • →Reassess after each 500-1000 mL bolus
  • →Monitor for fluid overload signs
  • →Target MAP ≥65 mmHg
  • →Consider additional fluids based on response

Success Criteria:

  • Hypotension: SBP <90 or MAP <65
  • Hypoperfusion: Lactate >2 mmol/L
4

Vasopressor Therapy

Initiate vasopressors for shock

HIGH

Actions:

  • →Start norepinephrine as first-line agent
  • →Target MAP ≥65 mmHg
  • →Use central line if possible
  • →Consider peripheral vasopressors if no central access
  • →Add vasopressin or epinephrine for refractory shock

Success Criteria:

  • Persistent hypotension after adequate fluid resuscitation
  • MAP <65 mmHg despite fluids

Required Equipment

•IV access supplies
•Blood culture bottles
•Lactate measurement device
•Blood pressure monitoring
•Fluid warmers
•Vasopressor infusion pumps

Protocol Medications

Norepinephrine

IV (preferably central line)

First-line vasopressor for septic shock

Adult Dose:0.05-3 mcg/kg/min IV infusion
Pediatric Dose:0.05-2 mcg/kg/min IV infusion
Onset:1-3 minutes
Duration:1-2 minutes after discontinuation

Evidence Base & References

  • 1.Evans L, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247.
  • 2.Singer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810.