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Emergency
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Sepsis / Septic Shock
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Hour-1 bundle: lactate, cultures, abx, fluids, vasopressors.
Decision
Outcome
Decision
Suspected sepsis (qSOFA ≥2 or organ dysfunction). Initial bundle within 1 hour?
✓
Lactate + blood cultures + broad-spectrum antibiotics + 30 mL/kg crystalloid for hypotension or lactate ≥4
✗
Wait for cultures before antibiotics
Decision
Persistent hypotension despite fluids?
✓
Start norepinephrine (1st-line vasopressor) to keep MAP ≥65
✓
Adequate perfusion → continue source control + tailored antibiotics
Outcome
Norepinephrine first; add vasopressin if escalating; epinephrine if refractory; consider hydrocortisone in vasopressor-refractory shock
ScvO₂ <70% may guide additional measures (transfusion, inotropes).
Outcome
Continue antibiotic course, de-escalate per cultures