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Table 2.22

Treatment Guidelines for Sepsis/Septic Shock

Goal: Early implementation and prevention of delays
InterventionKey Points
Measure lactate level
  • Remeasure lactate within 6 hours if initial lactate is >2 mmol/L
Obtain blood cultures before administering antibiotics
  • Ideally obtain 2 sets of blood cultures from 2 separate sites
  • Do not delay antibiotic administration if difficulty with obtaining blood cultures
Administer broad spectrum antibiotics
  • First dose of antibiotics can be given concurrently
  • If one IV present and antibiotics are not compatible, administer first dose of antibiotics from broadest to narrowest spectrum
  • Goal is to initiate antibiotic administration in 1 hour
  • As culture and sensitivities are available, narrow antibiotic track to reduce extended exposure of broad spectrum antibiotics
Rapid administration of 30 mL/kg crystalloid for hypotention (MAP < 65) or lactate >4 mmol/L
  • 0.9% sodium chloride (NS) is the preferred crystalloid
  • Dosing is based on actual body weight, not ideal body weight
  • Provider can use discretion in volume ordered, based on weight (morbid obesity) or disease process (CHF)
Vasopressors if hypotensive during/ after fluid administration
  • Norepinephrine is the preferred vasoactive agent
  • Goal of therapy is to maintain MAP >65