Septic shock is defined as a subset of sepsis with persistent hypotension requiring vasopressor therapy to maintain MAP ≥65 mmHg and serum lactate >2 mmol/L despite adequate fluid resuscitation (Sepsis-3 criteria). [1-2] It carries a mortality rate of approximately 40–50% and affects approximately 49 million sepsis cases worldwide annually, with 11 million sepsis-related deaths. [1][3]
1. History
- Source-directed HPI: Cough/dyspnea (pneumonia — most common source), dysuria/flank pain (UTI), abdominal pain (intra-abdominal), wound erythema/drainage (skin/soft tissue) [4]
- Timing and progression: Onset of symptoms, rapidity of decline, duration of fever, recent antibiotic use, prior hospitalizations
- Associated symptoms: Fever/chills, rigors, confusion, decreased urine output, malaise, myalgias
- Important negatives: Chest pain (ACS mimic), drug ingestion/overdose, recent procedures/surgeries, indwelling devices (lines, catheters, prosthetics), travel history, animal/insect exposures
- Medication history: Immunosuppressants, chemotherapy, beta-blockers (may mask tachycardia), antipyretics (may mask fever), recent antibiotics [5]
2. Alarm Features
- Hypotension refractory to fluid resuscitation (SBP <90, MAP <65)
- Altered mental status / acute encephalopathy
- Lactate ≥4 mmol/L (severe tissue hypoperfusion)
- Skin mottling, cyanosis, prolonged capillary refill time
- Oliguria/anuria (<0.5 mL/kg/hr)
- Rapidly escalating vasopressor requirements
- New-onset organ dysfunction: respiratory failure, coagulopathy (DIC), acute kidney injury [5-6]
- Sepsis can be difficult to recognize in the elderly, immunocompromised, and those presenting very early in the illness course [6]
3. Medications
Empiric Antimicrobials:
- Septic shock: Administer immediately, ideally within 1 hour of recognition (strong recommendation) [7]
- Broad-spectrum coverage targeting gram-negative and gram-positive organisms based on local susceptibility patterns [6]
- Add MRSA coverage (e.g., vancomycin) if high-risk (recent healthcare exposure, known colonization, skin/soft tissue source) [8]
- Consider antifungal coverage if high-risk for invasive fungal infection (prolonged ICU stay, TPN, immunosuppression) [9]
- Prolonged beta-lactam infusions (after initial bolus) improve outcomes over intermittent boluses [9]
Vasopressors:
- Norepinephrine — first-line vasopressor (strong recommendation) [8]
- Vasopressin (0.03 U/min) — add if norepinephrine dose reaches 0.25–0.5 mcg/kg/min [5][9]
- Epinephrine — third-line if MAP goals not met with norepinephrine + vasopressin [8]
- Can be initiated via peripheral IV (≥20-gauge) safely; do not delay for central access [6][10]
Corticosteroids:
- Hydrocortisone 200 mg/day IV (50 mg q6h or continuous infusion) ± fludrocortisone 50 mcg daily for patients with ongoing vasopressor requirements (conditional recommendation) [7-8]
- Accelerates shock reversal; uncertain mortality benefit [7-8]
- Monitor for hyperglycemia and hypernatremia [7]
Medications to Avoid:
- Hydroxyethyl starch — increased mortality [9]
- Synthetic colloid gelatin — insufficient evidence [9]
- Terlipressin — suggested against [8]
4. Diet
- NPO initially in critically ill/intubated patients
- Early enteral nutrition (within 24–48 hours of ICU admission) is preferred over parenteral nutrition once hemodynamically stable
- Avoid overfeeding; target caloric goals per ICU nutrition guidelines
- Adequate hydration is addressed through IV fluid resuscitation
5. Review of Systems
- Neurologic: Confusion, lethargy, agitation (septic encephalopathy)
- Respiratory: Dyspnea, tachypnea, cough, hypoxia (pneumonia, ARDS)
- Cardiovascular: Palpitations, chest pain (septic cardiomyopathy, new-onset atrial fibrillation)
- GI: Nausea, vomiting, diarrhea, abdominal pain (intra-abdominal source)
- GU: Dysuria, frequency, flank pain (urinary source)
- Skin: Rash, wound changes, erythema, warmth (cellulitis, necrotizing fasciitis)
- Musculoskeletal: Joint pain/swelling (septic arthritis), back pain (epidural abscess, osteomyelitis) [4][11]
6. Collateral History and Family History
- Collateral: Baseline mental status, functional status, recent hospitalizations, recent procedures, indwelling devices, known colonization with resistant organisms, advance directives/goals of care
- Family history: Immunodeficiency syndromes; genetic polymorphisms in innate immunity genes may influence sepsis susceptibility, though clinical utility is limited [12]
- Social context: Injection drug use (endocarditis), alcohol use disorder (aspiration pneumonia, SBP), homelessness, nursing home residence
7. Risk Factors
- Age: Extremes of age (infants, elderly ≥65) [12-13]
- Immunosuppression: HIV/AIDS, chemotherapy, transplant recipients, chronic corticosteroid use [13-14]
- Chronic organ failure: CKD (especially dialysis-dependent), cirrhosis, COPD, heart failure [15-16]
- Malignancy [15-16]
- Diabetes mellitus [13][17]
- Recent surgery or invasive procedures
- Indwelling devices: Central lines, urinary catheters, prosthetic joints/valves [11]
- Male sex, Black race (associated with higher incidence and mortality) [12][16]
- Cirrhosis is a particularly strong independent predictor of mortality in septic shock (adjusted OR 1.85) [16]
8. Differential Diagnosis
Approximately 20–40% of patients with suspected sepsis in the ED are ultimately diagnosed with a noninfectious sepsis mimic. [6] Critical differentials include:
- Cardiogenic shock — elevated JVP, pulmonary edema, cold extremities, echo with reduced EF [18]
- Hypovolemic shock — hemorrhage, dehydration, third-spacing
- Anaphylaxis — urticaria, angioedema, exposure history
- Pulmonary embolism — pleuritic chest pain, RV strain on echo/CT
- Adrenal crisis — hypotension refractory to fluids, hyperkalemia, hyponatremia
- Toxic ingestion/overdose — medication history, toxidrome features [19]
- Neuroleptic malignant syndrome / serotonin syndrome — medication history, rigidity, hyperthermia [11]
- Thyroid storm — tachycardia, hyperthermia, agitation, thyroid history
- Hemophagocytic lymphohistiocytosis (HLH) — pancytopenia, hyperferritinemia, hepatosplenomegaly [20]
- Pancreatitis — epigastric pain, lipase elevation
- Neurogenic shock — spinal cord injury, bradycardia with hypotension [19]
9. Past Medical History
- Prior episodes of sepsis (increased risk of recurrence)
- Chronic diseases: diabetes, CKD, cirrhosis, COPD, heart failure, malignancy
- Surgical history: splenectomy (encapsulated organisms), recent abdominal/urologic surgery
- Immunosuppressive medications or conditions
- Known colonization with MDR organisms (MRSA, VRE, ESBL-producing organisms)
- Baseline cardiac function (history of heart failure increases risk of septic cardiomyopathy) [21]
10. Physical Exam
Vital Signs:
Focused Exam:
- General: Toxic appearance, diaphoresis, altered mentation
- Skin: Mottling (especially over knees), delayed capillary refill (>3 sec), petechiae/purpura (DIC, meningococcemia), wound erythema/crepitus (necrotizing fasciitis)
- HEENT: Nuchal rigidity (meningitis), dental abscess, sinus tenderness
- Lungs: Crackles, decreased breath sounds, dullness to percussion
- Cardiovascular: New murmur (endocarditis), JVD, peripheral edema
- Abdomen: Peritoneal signs, distension, tenderness (intra-abdominal source)
- GU: CVA tenderness, suprapubic tenderness
- Extremities: Joint effusion/erythema (septic arthritis), IV site infection
- Spine: Midline tenderness (epidural abscess) [6][22]
11. Lab Studies
Initial Labs:
- Serum lactate — cornerstone biomarker; >2 mmol/L defines septic shock; serial trending guides resuscitation [1][8]
- CBC with differential — leukocytosis (>12,000), leukopenia (<4,000), bandemia (>10% bands)
- BMP/CMP — creatinine (AKI), glucose (hyperglycemia common), electrolytes
- Hepatic function panel — bilirubin, transaminases (hepatic dysfunction)
- Coagulation studies — PT/INR, fibrinogen, D-dimer (DIC screening)
- Blood cultures (≥2 sets from different sites) — obtain before antibiotics if possible without delaying treatment
- Urinalysis and urine culture
- Procalcitonin — may support diagnosis but should not be used in isolation to exclude sepsis [4][23]
- ABG/VBG — acid-base status, PaO2
- Type and screen if hemorrhage or surgical intervention anticipated
Monitoring Parameters:
- Serial lactate (target decreasing trend toward normal) [8]
- Urine output (target ≥0.5 mL/kg/hr)
- Capillary refill time (adjunct to guide resuscitation) [8]
12. Imaging
- Chest X-ray — first-line for suspected pulmonary source (pneumonia, empyema, ARDS)
- CT abdomen/pelvis with IV contrast — suspected intra-abdominal source (abscess, perforation, cholangitis)
- CT head — altered mental status without clear cause, concern for CNS infection
- Point-of-care ultrasound (POCUS) — assess cardiac function (EF, RV dilation), IVC collapsibility (volume status), lung (B-lines, effusion), free fluid (FAST) [18]
- CT chest — if CXR nondiagnostic and pulmonary source suspected
- MRI spine — suspected epidural abscess
- Imaging should be source-directed based on clinical suspicion [4]
13. Special Tests
Scoring Systems:
- SOFA score — defines organ dysfunction (increase ≥2 points = sepsis); superior prognostic accuracy in ICU [2][24]
- qSOFA (RR ≥22, altered mentation, SBP ≤100) — bedside screening tool for non-ICU settings; limited sensitivity [9][25]
- APACHE II / SAPS II — ICU severity scoring; higher scores independently predict mortality [16]
Point-of-Care Tests:
- Bedside echocardiography — assess for septic cardiomyopathy (biventricular dysfunction), cardiac tamponade, PE [18][26]
- Passive leg raise test — dynamic assessment of fluid responsiveness (>10% increase in stroke volume suggests fluid responsiveness) [5][8]
- Multiplex PCR pathogen panels — rapid pathogen identification from blood cultures [5]
14. ECG
- Sinus tachycardia — most common finding (39% of sepsis patients) [27]
- New-onset atrial fibrillation/flutter — occurs in ~9% of sepsis patients; associated with worse outcomes (OR 2.19 for poor outcomes) [27]
- QT prolongation — common (54.4%); associated with adverse outcomes [27]
- ST-T wave changes — may represent demand ischemia or septic cardiomyopathy; must differentiate from ACS [28-29]
- ECG should be obtained in all patients with septic shock to evaluate for arrhythmia, ischemia, and cardiac dysfunction [28]
- Troponin elevation is common in sepsis and does not necessarily indicate ACS; correlate with clinical picture and echocardiography [28]
15. Assessment
Definition (Sepsis-3): Sepsis with vasopressor requirement to maintain MAP ≥65 mmHg AND lactate >2 mmol/L after adequate fluid resuscitation. [1-2]
Severity Stratification:
- Mortality increases with higher SOFA scores (1.21 per point increase), higher APACHE II scores (1.10 per point increase), and elevated lactate (1.13 per 1 mmol/L increase) [16]
- Respiratory source of sepsis carries higher mortality than urinary source [16]
- AKI at presentation is an independent predictor of mortality (adjusted OR 1.88) [16]
Atypical Presentations:
- Elderly patients may present with hypothermia, confusion, or functional decline without fever [5]
- Immunocompromised patients may lack typical inflammatory signs [6]
- Beta-blockers may mask tachycardia; antipyretics may mask fever [5]
Complications:
- Intensive Care Medicine[3]
16. Treatment Plan
Immediate Stabilization (Hour-1 Bundle):
- Measure lactate (remeasure if initial >2 mmol/L)
- Obtain blood cultures before antibiotics (do not delay antibiotics)
- Administer broad-spectrum IV antibiotics within 1 hour [7]
- Begin IV crystalloid resuscitation: at least 30 mL/kg within 3 hours for hypoperfusion/shock [7]
- Balanced crystalloids (e.g., lactated Ringer's) preferred over normal saline [9]
- Use adjusted body weight for BMI >30 [7]
- Start vasopressors if hypotension persists despite fluids — target MAP ≥65 mmHg [8]
Vasopressor Escalation:
- Norepinephrine → add vasopressin (0.03 U/min) → add epinephrine [8]
- For cardiac dysfunction with persistent hypoperfusion: add dobutamine to norepinephrine or use epinephrine alone [8]
Adjunctive Therapies:
- Hydrocortisone 200 mg/day IV ± fludrocortisone 50 mcg daily for refractory shock [7-8]
- Source control — drain abscesses, remove infected devices, debride necrotic tissue as soon as feasible [3]
- Lung-protective ventilation if intubated (tidal volume 6 mL/kg ideal body weight, plateau pressure <30 cmH2O)
- Glucose management — target glucose ≤180 mg/dL
- VTE prophylaxis and stress ulcer prophylaxis per ICU protocols
Ongoing Resuscitation:
- Guide further fluids using dynamic measures (passive leg raise, stroke volume variation, pulse pressure variation) rather than static measures (CVP) [8-9]
- Target decreasing lactate trend and capillary refill time normalization [5][8]
17. Disposition
Admission Criteria:
- All patients with septic shock require ICU admission [8]
- ICU admission should occur within 6 hours of recognition; delays increase mortality [8]
Observation Indications:
Specialist Consultation Triggers:
- Critical care/intensivist — all septic shock patients
- Surgery — source control needs (abscess drainage, bowel perforation, necrotizing fasciitis)
- Infectious disease — MDR organisms, unclear source, immunocompromised host, failure to improve
- Cardiology — new cardiac dysfunction, concern for endocarditis or ACS
18. Follow Up / Return Precautions
Inpatient Monitoring:
- Serial lactate q2–4h until trending down
- Continuous hemodynamic monitoring (arterial line recommended for vasopressor use)
- Daily reassessment of antibiotic spectrum; narrow based on culture/sensitivity data
- Reassess for source control if failing to improve
Post-Discharge:
- Survivors are at high risk for rehospitalization within 12 months, cognitive impairment, physical disability, and psychological sequelae (PTSD, depression) [3]
- Follow-up within 1–2 weeks of discharge with PCP
- Medication reconciliation (antibiotics completion, chronic medication adjustments)
- Screening for post-sepsis syndrome: fatigue, cognitive changes, functional decline
- Return precautions: fever, recurrent hypotension, confusion, decreased urine output, worsening symptoms at infection site
References
1. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). — Shankar-Hari M, Phillips GS, Levy ML, et al. The Journal of the American Medical Association. 2016.
2. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). — Shankar-Hari M, Phillips GS, Levy ML, et al. The Journal of the American Medical Association. 2016.
3. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). — Shankar-Hari M, Phillips GS, Levy ML, et al. The Journal of the American Medical Association. 2016.
4. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). — Singer M, Deutschman CS, Seymour CW, et al. The Journal of the American Medical Association. 2016.
5. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). — Singer M, Deutschman CS, Seymour CW, et al. The Journal of the American Medical Association. 2016.
6. Current Standard of Care for Septic Shock. — Delaney A, Borges-Sa M, Chew MS, et al. Intensive Care Medicine. 2025.
7. Current Standard of Care for Septic Shock. — Delaney A, Borges-Sa M, Chew MS, et al. Intensive Care Medicine. 2025.
8. Emergency Medicine Updates: Evaluation and Diagnosis of Sepsis and Septic Shock. — Long B, Gottlieb M. The American Journal of Emergency Medicine. 2025.
9. Emergency Medicine Updates: Evaluation and Diagnosis of Sepsis and Septic Shock. — Long B, Gottlieb M. The American Journal of Emergency Medicine. 2025.
10. Sepsis and Septic Shock. — Meyer NJ, Prescott HC. The New England Journal of Medicine. 2024.
11. Sepsis and Septic Shock. — Meyer NJ, Prescott HC. The New England Journal of Medicine. 2024.
12. Early Care of Adults With Suspected Sepsis in The Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report. — Yealy DM, Mohr NM, Shapiro NI, et al. Annals of Emergency Medicine. 2021.
13. Early Care of Adults With Suspected Sepsis in The Emergency Department and Out-of-Hospital Environment: A Consensus-Based Task Force Report. — Yealy DM, Mohr NM, Shapiro NI, et al. Annals of Emergency Medicine. 2021.
14. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. — Prescott HC, Antonelli M, Alhazzani W, et al. Critical Care Medicine. 2026.
15. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. — Prescott HC, Antonelli M, Alhazzani W, et al. Critical Care Medicine. 2026.
16. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. — Evans L, Rhodes A, Alhazzani W, et al. Critical Care Medicine. 2021.
17. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. — Evans L, Rhodes A, Alhazzani W, et al. Critical Care Medicine. 2021.
18. Surviving Sepsis: Updated Guidelines From the Society of Critical Care Medicine. — Arnold MJ. American Family Physician. 2022.
19. Surviving Sepsis: Updated Guidelines From the Society of Critical Care Medicine. — Arnold MJ. American Family Physician. 2022.
20. Emergency Medicine Updates: Management of Sepsis and Septic Shock. — Long B, Gottlieb M. The American Journal of Emergency Medicine. 2025.
21. Emergency Medicine Updates: Management of Sepsis and Septic Shock. — Long B, Gottlieb M. The American Journal of Emergency Medicine. 2025.
22. Consideration of Occult Infection and Sepsis Mimics in the Sick Patient Without an Apparent Infectious Source. — Boushra MN, Miller SN, Koyfman A, Long B. The Journal of Emergency Medicine. 2019.
23. Consideration of Occult Infection and Sepsis Mimics in the Sick Patient Without an Apparent Infectious Source. — Boushra MN, Miller SN, Koyfman A, Long B. The Journal of Emergency Medicine. 2019.
24. Severe Sepsis and Septic Shock. — Angus DC, van der Poll T. The New England Journal of Medicine. 2013.
25. Severe Sepsis and Septic Shock. — Angus DC, van der Poll T. The New England Journal of Medicine. 2013.
26. Risk Factors for Hospitalization Due to Community-Acquired Sepsis - A Population-Based Case-Control Study. — Henriksen DP, Pottegård A, Laursen CB, et al. PloS One. 2015.
27. Risk Factors for Hospitalization Due to Community-Acquired Sepsis - A Population-Based Case-Control Study. — Henriksen DP, Pottegård A, Laursen CB, et al. PloS One. 2015.
28. Septic Shock. — Annane D, Bellissant E, Cavaillon JM. Lancet. 2005.
29. Septic Shock. — Annane D, Bellissant E, Cavaillon JM. Lancet. 2005.
30. The Impact of Comorbidities and COVID-19 on the Evolution of Community Onset Sepsis. — de Araújo GC, Pardini A, Lima C. Scientific Reports. 2023.
31. The Impact of Comorbidities and COVID-19 on the Evolution of Community Onset Sepsis. — de Araújo GC, Pardini A, Lima C. Scientific Reports. 2023.
32. Prognostic Factors Associated With Mortality in Septic Shock: A Systematic Review and Meta-Analysis. — Jung RG, Gupta A, Stotts C, et al. The Lancet. Respiratory Medicine. 2026.
33. Prognostic Factors Associated With Mortality in Septic Shock: A Systematic Review and Meta-Analysis. — Jung RG, Gupta A, Stotts C, et al. The Lancet. Respiratory Medicine. 2026.
34. Impact of Cardiovascular and Metabolic Comorbidities on Severity and Outcomes of Hospital-Acquired Sepsis in Intensive Care Patients: A Case-Control Study. — Roy A, Krishnasamy V, Mitra S, et al. BMC Infectious Diseases. 2026.
35. Impact of Cardiovascular and Metabolic Comorbidities on Severity and Outcomes of Hospital-Acquired Sepsis in Intensive Care Patients: A Case-Control Study. — Roy A, Krishnasamy V, Mitra S, et al. BMC Infectious Diseases. 2026.
36. Circulatory Shock. — Vincent JL, De Backer D. The New England Journal of Medicine. 2013.
37. Circulatory Shock. — Vincent JL, De Backer D. The New England Journal of Medicine. 2013.
38. Clinical Mimics: An Emergency Medicine-Focused Review of Sepsis Mimics. — Long B, Koyfman A. The Journal of Emergency Medicine. 2017.
39. Clinical Mimics: An Emergency Medicine-Focused Review of Sepsis Mimics. — Long B, Koyfman A. The Journal of Emergency Medicine. 2017.
40. Sepsis in Patients Who Are Immunocompromised: Diagnostic Challenges and Future Therapies. — Deinhardt-Emmer S, Chousterman BG, Schefold JC, et al. The Lancet. Respiratory Medicine. 2025.
41. Sepsis in Patients Who Are Immunocompromised: Diagnostic Challenges and Future Therapies. — Deinhardt-Emmer S, Chousterman BG, Schefold JC, et al. The Lancet. Respiratory Medicine. 2025.
42. Identifying Predictors and Determining Mortality Rates of Septic Cardiomyopathy and Sepsis-Related Cardiogenic Shock: A Retrospective, Observational Study. — Hendrickson KW, Cirulis MM, Burk RE, et al. PloS One. 2023.
43. Identifying Predictors and Determining Mortality Rates of Septic Cardiomyopathy and Sepsis-Related Cardiogenic Shock: A Retrospective, Observational Study. — Hendrickson KW, Cirulis MM, Burk RE, et al. PloS One. 2023.
44. A Plea for Personalization of the Hemodynamic Management of Septic Shock. — De Backer D, Cecconi M, Chew MS, et al. Critical Care. 2022.
45. A Plea for Personalization of the Hemodynamic Management of Septic Shock. — De Backer D, Cecconi M, Chew MS, et al. Critical Care. 2022.
46. Sepsis: Diagnosis and Management. — Gauer R, Forbes D, Boyer N. American Family Physician. 2020.
47. Sepsis: Diagnosis and Management. — Gauer R, Forbes D, Boyer N. American Family Physician. 2020.
48. Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. — Raith EP, Udy AA, Bailey M, et al. The Journal of the American Medical Association. 2017.
49. Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. — Raith EP, Udy AA, Bailey M, et al. The Journal of the American Medical Association. 2017.
50. Plasma Interleukin-6 Concentration for the Diagnosis of Sepsis in Critically Ill Adults. — Molano Franco D, Arevalo-Rodriguez I, Roqué I Figuls M, et al. The Cochrane Database of Systematic Reviews. 2019.
51. Plasma Interleukin-6 Concentration for the Diagnosis of Sepsis in Critically Ill Adults. — Molano Franco D, Arevalo-Rodriguez I, Roqué I Figuls M, et al. The Cochrane Database of Systematic Reviews. 2019.
52. The Septic Heart: Current Understanding of Molecular Mechanisms and Clinical Implications. — Martin L, Derwall M, Al Zoubi S, et al. Chest. 2019.
53. The Septic Heart: Current Understanding of Molecular Mechanisms and Clinical Implications. — Martin L, Derwall M, Al Zoubi S, et al. Chest. 2019.
54. Association of Electrocardiogram Abnormalities With Clinical Outcomes in Emergency Department Sepsis Patients. — Kotruchin P, Chuehongthong M, Tangpaisarn T, et al. The Western Journal of Emergency Medicine. 2026.
55. Association of Electrocardiogram Abnormalities With Clinical Outcomes in Emergency Department Sepsis Patients. — Kotruchin P, Chuehongthong M, Tangpaisarn T, et al. The Western Journal of Emergency Medicine. 2026.
56. Current Challenges in Understanding, Diagnosing and Managing Sepsis-Induced Cardiac Dysfunction. — Paraschiv C, Popescu Moraru MR, Paduraru LF, et al. Journal of Critical Care. 2025.
57. Current Challenges in Understanding, Diagnosing and Managing Sepsis-Induced Cardiac Dysfunction. — Paraschiv C, Popescu Moraru MR, Paduraru LF, et al. Journal of Critical Care. 2025.
58. Septic Cardiomyopathy or Myocardial Infarction?: A Case Report of Septic Shock With ST-segment Elevation on ECG. — Gao H, Wang X, Yang Q. Medicine. 2025.
59. Septic Cardiomyopathy or Myocardial Infarction?: A Case Report of Septic Shock With ST-segment Elevation on ECG. — Gao H, Wang X, Yang Q. Medicine. 2025.