Structured resuscitation of the deteriorating patient (ABCDE)

The patient is in septic shock with multi-system compromise and requires immediate, simultaneous resuscitation by a team. Structure the answer around ABCDE, applied as an iterative cycle, with the sepsis bundle running in parallel.^[2]

Resuscitation and assessment. Call for senior and nursing help early and allocate roles. Assess the airway: confirm patency, suction secretions, and position the patient; he is maintaining his airway but is confused and at risk, so have airway equipment and a skilled clinician ready. For breathing, apply high-flow oxygen and reassess saturation, measure a work-of-breathing and examine for a focus; the respiratory rate of 32 with saturation of 90 percent on room air indicates respiratory compromise, so escalate to assisted ventilation if he tires. For circulation, establish two large-bore intravenous cannulae, take bloods including a venous gas and lactate, send cultures, and give a balanced crystalloid bolus, reassessing the response to each aliquot; target mean arterial pressure of 65 mmHg or above.^[2]

Time-critical sepsis bundle. This is sepsis with organ dysfunction and shock, so initiate a time-stamped bundle now: blood cultures before antibiotics where feasible, broad-spectrum intravenous antibiotics early, a measured fluid challenge for the hypotensive and lactate-raised patient, vasopressors for fluid-refractory hypotension to a mean arterial pressure target, source control, and serial lactate measurement. Each hour's delay to antibiotics is associated with increased mortality, so antibiotics must not wait for investigation results.^[1]

Reassessment and disposition. After each intervention, return to A and reassess against targets (oxygenation, blood pressure, perfusion, lactate, conscious level). Ongoing or worsening derangement despite resuscitation is an indication for early intensive-care involvement. Reassess continuously and communicate a structured handover.^[3]