To be completed within three hours

• Measure lactate level
• Obtain 2 or more blood cultures prior to administration of antibiotics
• Administer broad spectrum antibiotics
• Administer 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L

To be completed within six hours

• Start vasopressor therapy for hypotension that does not respond to initial fluid resuscitation, to maintain a mean arterial pressure (MAP) >65 mmHg.
• In the event of persistent hypotension after initial fluid administration (MAP < 65 mmHg) or if initial lactate was ≥4 mmol/L, re-assess volume status and tissue perfusion and document findings with:

  • EITHER:

    Repeat focused exam (after initial fluid resuscitation) including vital signs, capillary refill, pulse, and skin findings.

  • OR TWO OF THE FOLLOWING
    • Measure CVP
    • Measure ScvO₂
    • Bedside cardiovascular ultrasound
    • Dynamic assessment of fluid responsiveness with passive leg raise or fluid challenge
• Re-measure lactate if initial lactate was elevated