Red flags
- Lactate >4
- Need for vasopressor = septic shock
- Purpuric rash (meningococcaemia)
- Necrotising fasciitis
First steps
- Measure lactate
- Blood cultures ×2 before antibiotics
- Broad-spectrum antibiotics within 1 h
- IV crystalloid 30 mL/kg over 3 h
- Vasopressor (norad) if MAP <65 despite fluid
Key investigations
- Blood cultures, lactate, ABG
- FBC, U&E, LFT, coag, CRP, procalcitonin
- Urinalysis + culture, CXR, imaging by source
Differentials
- Distributive: anaphylaxis, neurogenic
- Cardiogenic shock
- PE
Initial management
- Norad first, target MAP ≥65
- Add vasopressin 0.03 U/min if escalating
- Hydrocortisone 200 mg/day if refractory
- Source control ASAP
Referral
- ICU/HDU
- Source-specific specialist (surgery, ID)
AI clinical assessment
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This tool is for educational and clinical support only. It does not replace professional medical judgment or institutional protocols.
