Life-threatening organ dysfunction caused by a dysregulated host response to infection; septic shock = persisting hypotension requiring vasopressors with lactate >2 mmol/L despite fluids.
Clinical features
- • Fever or hypothermia
- • Tachycardia, tachypnoea
- • Altered mental status
- • Hypotension, oliguria
Investigations
- • Lactate
- • Blood cultures ×2 pre-antibiotics
- • FBC, U&E, LFT, CRP, coagulation
- • Source imaging (CXR, US, CT)
Diagnosis
- • qSOFA ≥2 or SOFA rise ≥2
- • Sepsis-3 definition
Differential diagnosis
- • Cardiogenic shock
- • Hypovolaemic shock
- • Anaphylaxis
- • Adrenal crisis
- • PE
Management
- • Hour-1 bundle: lactate, cultures, broad-spectrum abx, 30 mL/kg crystalloid, vasopressors for MAP ≥65
- • Source control
- • Reassess perfusion (cap refill, lactate clearance)
Drug therapy
- • Piperacillin-tazobactam 4.5 g IV q8h (start dose)
- • Add vancomycin if MRSA risk
- • Noradrenaline 0.05–0.5 µg/kg/min
- • Hydrocortisone 200 mg/day if refractory shock
Complications
- • MODS
- • ARDS
- • DIC
- • AKI
- • Death
Clinical pearls
- • Antibiotics within 1 h save lives
- • Lactate clearance >10%/h predicts survival
References
- • Surviving Sepsis Campaign 2021
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