Red flags
- Suspected infection + hypotension, hypoxia, altered mental status
- Tachypnea, tachycardia, fever or hypothermia, oliguria
- Elevated lactate (≥ 2 mmol/L) or rising trend
Recognize sepsis early
The Hour-1 Bundle
| Action | What to do | Referral |
|---|---|---|
| Measure lactate | Draw initial lactate; recheck if ≥ 2 mmol/L | Lactate |
| Obtain blood cultures | Before antibiotics (don’t delay therapy excessively) | Blood cultures |
| Give broad-spectrum antibiotics | Administer within 1 hour of recognition; tailor to source/risks | Antibiotics |
| Rapid crystalloid bolus | 30 mL/kg for hypotension or lactate ≥ 4 mmol/L | Fluid resuscitation |
| Start vasopressors if needed | If hypotensive during/after fluids, start to maintain MAP ≥ 65 mmHg | Norepinephrine |
Fluids & Vasopressors
Fluids
- Use isotonic crystalloid; reassess after each bolus (dynamic measures, lung exam, ultrasound)
- Be cautious in heart failure or renal failure; individualize
Vasopressor strategy
- First line: norepinephrine
- Add vasopressin (fixed dose) if refractory; consider epinephrine as second line
- Consider stress-dose corticosteroids in persistent shock despite adequate fluids/pressors
Targets & Ongoing Reassessment
- MAP ≥ 65 mmHg (individualize for chronic hypertension)
- Urine output ≥ 0.5 mL/kg/hr; monitor with renal labs
- Trend lactate clearance and clinical perfusion
- Early arterial line and central access per ICU protocol
- Ventilation/oxygen: avoid hypoxia; consider oxygen therapy and lung-protective settings for ARDS
- Glycemic control: avoid severe hyper/hypoglycemia
- VTE and stress-ulcer prophylaxis as indicated
Source Control & Diagnostics
- Image likely sources (CXR, CT, POCUS) and obtain focused cultures
- Remove infected lines, drain abscesses, debride tissue, or perform biliary/urinary decompression promptly
Cited Keywords & Referral Links (gyathshammha.com)
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Bottom line
For suspected sepsis, act within the first hour: check lactate, draw blood cultures, give antibiotics, deliver a 30 mL/kg fluid bolus, and start norepinephrine if MAP stays low—while moving toward definitive source control and reassessing perfusion continuously.
This page is for education and does not replace local protocols or specialist advice.