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Recognition and activation
Sepsis recognition and escalation
Suspected infection plus acute organ dysfunction
Acute altered mental status
New hypotension
New hypoxemia
Oliguria
Lactate elevation
Septic shock recognition
Vasopressor requirement for MAP 65 mmHg or higher
Lactate greater than 2 mmol/L despite adequate volume resuscitation
Severe sepsis terminology
Severe sepsis term no longer used in Sepsis 3 definitions
Coding and legacy documentation may still reference severe sepsis
Team activation triggers
Persistent hypotension after initial fluid
Lactate 4 mmol/L or higher
Rapidly increasing oxygen requirement
New need for vasopressors
Concern for immediate source control
Immediate resuscitation
ABCs and time zero actions
Airway and breathing priorities
Work of breathing and mental status deterioration
High flow nasal cannula or NIV if appropriate
Intubation preparation for refractory hypoxemia or exhaustion
Circulation priorities
Large bore IV access times two
Central access if ongoing vasopressor need
Peripheral vasopressor pathway if central delay
Proximal large vein site preference
Frequent site checks for extravasation
Monitoring
Continuous cardiac monitoring
Pulse oximetry
Noninvasive BP cycling every 2 to 3 minutes until stable
Arterial line if ongoing vasopressor titration
Hemodynamic and perfusion goals
Resuscitation targets
Mean arterial pressure 65 mmHg or higher
Higher targets if chronic hypertension or elevated ICP concern
Lower targets may be acceptable in select patients with adequate perfusion markers
Perfusion markers
Mental status improvement
Urine output 0.5 mL/kg/hour or higher
Capillary refill time adjunct
Lactate trend for severity and clearance
Shock reassessment loop
After each intervention repeat perfusion assessment
If worsening perfusion escalate vasopressors and source control pathway
Early bundle elements
Initial bundle within hours
Lactate
Baseline lactate
Repeat lactate if initial 2 mmol/L or higher
Cultures
Blood cultures times two before antibiotics when feasible
Do not delay antibiotics for cultures in shock
Broad spectrum antimicrobials
Immediate for possible septic shock or high likelihood sepsis
Within 3 hours for suspected sepsis without shock when feasible
Crystalloid resuscitation
30 mL/kg for hypotension or lactate 4 mmol/L or higher
Earlier vasopressors if fluid nonresponsive or pulmonary edema risk
Source control planning
Imaging and consults for drainage or surgery
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.