Sepsis and Septic Shock

Emergency Medicine

Life-threatening organ dysfunction from dysregulated host response to infection (Sepsis-3).

Investigations

  • Blood cultures × 2 before antibiotics
  • Lactate, ABG, FBC, U&E, LFT, coag, CRP
  • Urinalysis + culture, imaging by source

Diagnosis

  • Suspected infection + qSOFA ≥2 or SOFA ↑ ≥2
  • Septic shock: sepsis + vasopressor need + lactate >2 despite fluids

Management

  • Hour-1 bundle: lactate, cultures, broad-spectrum antibiotics, 30 mL/kg crystalloid, vasopressors to MAP ≥65
  • Norad first line; add vasopressin 0.03 U/min if escalating
  • Hydrocortisone 200 mg/day in refractory shock
  • Source control ASAP

Complications

  • Multiorgan failure, ARDS, DIC, death

References

  • Surviving Sepsis Campaign 2021

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