Sepsis is a medical emergency.
The accepted principles of treatment include prompt administration of antibiotics (target to administer within one hour of suspecting sepsis), source control, intravenous fluid therapy and organ system support with vasopressor drugs, mechanical ventilation, and renal replacement therapy as required.
The Surviving Sepsis Campaign promulgates guidelines for the management of severe sepsis and septic shock, and the current iteration dates from 2012 (9); the next update should be complete and ready for dissemination in 2016. However, compliance with international guidelines for the management of sepsis remains low even in countries where the guidelines have been embraced (7;8).
- Assess for airway patency and administer oxygen
- Obtain IV access, blood cultures and baseline blood tests (including lactate)
- Other diagnostic samples if they will not delay antibiotic treatment (e.g. sputum, urine, pus)
- Prescribe and administer antibiotics (should be administered in first hour)
- IV fluid bolus if patient showing signs of shock/hypoperfusion – 250-500 mL crystalloid (e.g. N/Saline, Hartmanns or Plasmalyte) repeated as required.
- Seek senior help and transfer to ICU if transient or no response to treatment
- Examination for source of sepsis if not already clear
- Monitor fluid balance and urine output