EM · Sepsis and septic shock (approach)

Sepsis and septic shock — the emergency department approach

Also known as Sepsis · Septic shock · Sepsis-3 · The Hour-1 bundle · qSOFA · The septic patient

Sepsis is the life-threatening organ dysfunction caused by a dysregulated host response to infection, defined by Sepsis-3 as suspected infection with an acute rise in the SOFA score of 2 or more, and septic shock as sepsis requiring vasopressors to hold a mean arterial pressure of 65 or above with a serum lactate over 2 mmol per litre despite adequate fluid. The emergency department approach rests on the qSOFA prompt (a respiratory rate of 22 or above, an altered mentation, a systolic blood pressure of 100 or below) and delivers the Surviving Sepsis Campaign Hour-1 bundle — the lactate, the blood cultures before the antibiotic, the broad-spectrum antibiotics (ceftriaxone 2 g IV, piperacillin-tazobactam 4.5 g IV, meropenem 1 g IV; vancomycin 1.5 g IV for MRSA; metronidazole 500 mg IV for anaerobic cover), the 30 mL per kilogram crystalloid, and the early vasopressor for a mean arterial pressure below 65 — followed by the lactate-guided resuscitation and the source control. The differential is the other shock states and the SIRS mimics. ACEM-primary, globally tagged.

Checked against its sources on 1 Sept 2026