›Immediate stabilization workflow
›Monitoring and access
›Continuous pulse oximetry
›Cardiac monitor
›Blood pressure cycling
›Two large bore IV
›IO access if IV failure
›Oxygenation and ventilation
›Supplemental oxygen for oxygen saturation under 92 percent
›Early airway plan for impending fatigue
›Immediate labs and tests
›Point of care glucose
›Lactate
›ECG
›Time critical bundle
›Antibiotics timing
›Within 1 hour for shock concern
›As soon as possible for suspected sepsis without shock
›Cultures timing
›Blood cultures before antibiotics when feasible
›Do not delay antibiotics for difficult access
›Fluid resuscitation trigger
›Hypotension
›Lactate 4 mmol/L or higher
›Empiric antibiotic principles
›Local antibiogram dependent selection
›Source directed coverage
›MRSA coverage when risk present
›Antipseudomonal coverage when risk present
›Example adult regimens
›Piperacillin tazobactam IV 4.5 g every 6 hours
›Renal adjustment required
›Allergy cross reactivity consideration
›Ceftriaxone IV 2 g daily
›Limited pseudomonas coverage
›Biliary sludging risk
›Vancomycin IV 15 to 20 mg per kg loading dose
›Therapeutic drug monitoring
›Infusion reaction mitigation
›Meropenem IV 1 g every 8 hours
›Reserved for resistant risk
›Seizure risk with high levels
Fluids and vasoactive support
›Crystalloid resuscitation
›Balanced crystalloid preferred when available
›Initial bolus 30 mL per kg for shock physiology
›Reassessment after each 500 to 1000 mL
›Vasopressors
›Norepinephrine IV infusion start 0.05 mcg per kg per minute
›Titrate to MAP 65 mmHg or higher
›Central line preferred
›Vasopressin IV infusion 0.03 units per minute
›Adjunct to reduce norepinephrine dose
›Not first line monotherapy
›Epinephrine IV infusion as add on
›Consider when refractory hypotension
›Lactate interpretation caution
›Inotrope for myocardial dysfunction
›Dobutamine IV infusion 2.5 to 20 mcg per kg per minute
›Consider with low cardiac output physiology
›Monitor for tachyarrhythmia
Source control and adjuncts
›Source control actions
›Drainage of abscess
›Removal of infected line
›Relief of urinary obstruction
›Corticosteroids for refractory shock
›Hydrocortisone IV 50 mg every 6 hours
›Consider when vasopressor refractory
Monitoring and reassessment loop
›Reassessment cadence
›Repeat vitals every 15 minutes during resuscitation
›Repeat mental status checks
›Urine output monitoring
›Targets
›MAP 65 mmHg or higher
›Urine output 0.5 mL per kg per hour or higher
›Lactate downtrend
›Immunocompromised
›Broad early coverage
›Early infectious diseases consultation
›Pregnancy and postpartum
›Obstetrics consultation
›Fetal considerations when viable gestation
›Neutropenic fever
›Antipseudomonal beta lactam priority
›Early oncology involvement