MedBalans

Sepsis / Septic Shock

Adults · emergency only · brief protocol

Algorithm

  1. Suspect infection + organ dysfunction (qSOFA/NEWS as screen only — not diagnosis).
  2. ABC; high-flow O₂ if hypoxic; continuous monitoring.
  3. IV access; blood cultures BEFORE antibiotics when it does not delay care >45–60 min.
  4. Start empiric IV antibiotics within 1 h of recognition of septic shock / likely sepsis.
  5. 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L (reassess; avoid overload).
  6. If still hypotensive after fluids: noradrenaline first-line vasopressor (MAP ≥65 mmHg target typical).
  7. Source control (drain, remove device, surgery) as soon as feasible.
  8. Escalate to ICU; serial lactate and reassessment.

Red flags

  • • Refractory hypotension
  • • Lactate rising / multi-organ failure
  • • Need for airway protection

Medications by step

Antibiotics

  • Empiric broad-spectrum IV per local antibiogram (e.g. piperacillin–tazobactam ± vancomycin if MRSA risk) · IV

    Per local protocol / weight

Fluids

  • Balanced crystalloid · IV

    Up to ~30 mL/kg initial, then reassessment

Vasopressor

  • Noradrenaline · IV infusion

    Titrate to MAP target (often start ~0.05–0.1 mcg/kg/min)

References

  • • Surviving Sepsis Campaign (2021)

Updated: July 2026