›Sepsis management bundle
›Fluids
›Balanced crystalloid 30 mL/kg for hypotension or lactate 4 mmol/L or higher
›Reassess after each bolus
›Pulmonary edema monitoring
›Additional boluses guided by perfusion
›MAP response
›Lactate trend
›Vasopressors
›Initiate norepinephrine for persistent hypotension
›Titrate to MAP 65 mmHg
›Central line preferred
›Add vasopressin if escalating norepinephrine dose
›Fixed dose strategy
›Catecholamine sparing
Definitive source control
›Operative management
›Emergent surgical exploration and debridement
›All necrotic tissue to viable bleeding margins
›Fascia assessment
›Muscle viability assessment
›Repeat debridement planned
›Re look within 12 to 24 hours typical
›Serial debridements until clean
›Wound management after debridement
›Negative pressure wound therapy when appropriate
›After adequate source control
›Reduce wound care burden
›Diversion procedures when needed
›Colostomy for fecal contamination risk
›Urinary diversion for urethral involvement
Empiric antimicrobial therapy
›Broad spectrum coverage strategy
›Coverage targets
›Gram negative including Enterobacterales
›Sepsis associated bacteremia risk
›ESBL risk assessment
›Anaerobes
›Bacteroides and Clostridium species
›Perineal flora source
›Streptococci and Staphylococcus including MRSA when risk
›Skin source contribution
›Prior MRSA colonization
›Core regimen options
›Piperacillin tazobactam IV 4.5 g every 6 hours
›Renal adjustment required
›Extended infusion option per local protocol
›Meropenem IV 1 g every 8 hours
›ESBL coverage
›Renal adjustment required
›Imipenem cilastatin IV 500 mg every 6 hours
›Broad anaerobe coverage
›Seizure risk in CNS disease
›Toxin suppression adjunct
›Clindamycin IV 900 mg every 8 hours
›Streptococcal toxin inhibition
›Add even with beta lactam therapy
›MRSA agents when indicated
›Vancomycin IV per weight based dosing and levels
›Loading dose in severe sepsis per local protocol
›Trough or AUC monitoring per local protocol
›Linezolid IV 600 mg every 12 hours
›Alternative to vancomycin
›Avoid with serotonergic drug interaction risk
›Antifungal consideration
›If profound immunosuppression or yeast on gram stain, initiate echinocandin
›Caspofungin IV 70 mg loading then 50 mg daily
›Micafungin IV 100 mg daily
›Hyperbaric oxygen therapy
›Adjunct after debridement and stabilization
›Consider when available without delaying surgery
›Potential benefit in selected cases
›Not a substitute for surgery
›Source control priority
›Antibiotics priority
Glycemic and supportive care
›Glucose management
›ICU insulin protocol
›Avoid severe hyperglycemia
›Avoid hypoglycemia
›Electrolyte monitoring
›Potassium shifts with insulin
›Magnesium replacement as needed
›Analgesia and sedation
›Multimodal pain control
›Opioid titration with monitoring
›Avoid hypotension worsening
›Procedural analgesia for dressing changes
›Ketamine option if hemodynamically unstable
›Continuous monitoring required