🚑 EmergencyInfectious / Critical careStudentInternResident

Sepsis & Septic Shock

Also known as: septicaemia · blood infection · septic shock

Life-threatening organ dysfunction from a dysregulated host response to infection. Early recognition and the “hour-1 bundle” save lives; septic shock adds fluid-refractory hypotension.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Any infection can progress to sepsis; risk is higher at the extremes of age and with immunosuppression, diabetes, chronic illness, recent surgery or indwelling devices.

Red flags — escalate / refer

qSOFA/NEWS features — new confusion, respiratory rate ≥22, systolic BP ≤100 mmHg — with suspected infection → act now.
Lactate ≥2 mmol/L, or hypotension needing vasopressors after fluids = septic shock → escalate to critical care.
Mottled skin, poor urine output, rapid deterioration → senior review.

Work-up / diagnosis

1Recognise sepsis: suspected infection PLUS organ dysfunction (rise in SOFA; qSOFA at the bedside).
2Take blood cultures BEFORE antibiotics — but never delay antibiotics to obtain them.
3Send lactate, CBC, renal & liver function, coagulation; find and control the source (imaging, drainage).

Management — overview

Deliver the hour-1 bundle: measure lactate; blood cultures before antibiotics; broad-spectrum antibiotics within 1 hour; IV crystalloid for hypotension/lactate ≥4; vasopressors to keep MAP ≥65 mmHg.
Give 30 mL/kg IV crystalloid for hypotension or lactate ≥4 mmol/L, then reassess fluid responsiveness dynamically.
Start noradrenaline (first-line vasopressor) if hypotension persists during/after fluids.
Achieve source control as early as possible; re-measure lactate to track response.
De-escalate antibiotics once cultures/sensitivities return.

In-depthFull dosing & advanced protocol

Drug dosing

IV crystalloid (balanced solution or 0.9% saline)

Hypotension or lactate ≥4

Adult dose: 30 mL/kg within the first 3 h; then titrate to dynamic measures
Route: Intravenous

Caution: Reassess after each bolus — avoid fluid overload, especially in cardiac/renal disease.

OtherSurviving Sepsis Campaign — International Guidelines ↗

Empirical broad-spectrum antibiotics

Within 1 hour of recognition

Adult dose: Choose by suspected source + local antibiogram; de-escalate on cultures
Route: Intravenous

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

Noradrenaline (norepinephrine)

Fluid-refractory hypotension (septic shock)

Adult dose: First-line vasopressor; titrate to MAP ≥65 mmHg
Route: IV infusion (central access preferred)

OtherSurviving Sepsis Campaign — International Guidelines ↗

Refractory shock & adjuncts

Add vasopressin if noradrenaline dose is climbing; consider low-dose corticosteroids in vasopressor-refractory shock.
Source control (drain abscess, remove infected device) is as important as antibiotics.
Track lactate clearance and organ function; involve critical care early.

OtherSurviving Sepsis Campaign — International Guidelines ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV crystalloid (balanced solution or 0.9% saline)

Empirical broad-spectrum antibiotics

Noradrenaline (norepinephrine)

📈 Refractory shock & adjuncts

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV crystalloid (balanced solution or 0.9% saline)

Empirical broad-spectrum antibiotics

Noradrenaline (norepinephrine)

📈 Refractory shock & adjuncts

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Refractory shock & adjuncts

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Refractory shock & adjuncts

References