← Diagnosis and Management Guides
Sepsis / Septic Shock
Key considerations: Septic shock, Necrotizing fasciitis, Meningitis
Cannot miss
- Septic shock
- Necrotizing fasciitis
- Meningitis
- Endocarditis
Likely diagnoses
- Pneumonia-related sepsis
- Urinary sepsis
- Intra-abdominal sepsis
- Skin/soft tissue source
Red flags
- Lactate >4
- Vasopressor requirement
- Altered mental status
- Anuria
Workup
- history: Source symptoms, immunocompromised status, recent procedures; exam: Full physical exam with focus on all potential sources; labs: CBC, BMP, lactate, procalcitonin, blood cultures x2 BEFORE antibiotics, UA/UCx; imaging: Source-directed imaging (CXR, CT abdomen); bedside: qSOFA, SOFA score
Management
- immediate: Blood cultures then broad-spectrum antibiotics within 1 hour; 30 mL/kg crystalloid for hypotension/lactate ≥4; Reassess volume status after initial bolus; general: Norepinephrine first-line vasopressor (target MAP ≥65); Add vasopressin if norepinephrine >0.25 mcg/kg/min; Source control (drainage, debridement)
Disposition
- admit: All sepsis patients — ICU if shock or organ failure; discharge: Never; consults: ID, surgery if source control needed
Clinical pearls
- Hour-1 bundle: cultures, antibiotics, lactate, fluids — time to antibiotics is the strongest modifiable mortality factor
- Reassess volume responsiveness — not all patients need 30 mL/kg (lung ultrasound helps)
Source and review
- Surviving Sepsis Campaign 2021. Last reviewed: 2024-11-01