Sepsis and septic shock are medical emergencies requiring urgent assessment, aggressive management and repeated revaluation of the response to treatment. Sepsis management is simplified using the “bundle” approach.
The 1st hour of the patient with sepsis and septic shock within the healthcare facility is the GOLDEN HOUR and appropriate management can make a significant difference to patient outcomes (box 1).
Box 1: Hour-1 Surviving Sepsis Campaign Bundle of Care: The Golden Hour
- Measure lactate level. Re-measure if initial lactate level > 2 mmol/L.*
- Obtain blood cultures before administering antibiotics.**
- Administer broad-spectrum antibiotics.
- Begin rapid IVadministration of 30mL/kg crystalloid for hypotension or lactate level ≥ 4 mmol/L.***
- Apply vasopressors if patient is hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg. ****
*"Time zero" or "time of presentation" is defined as the time of triage in the emergency department or, if presenting from another healthcare facility, from the earliest time-point in the treatment chart wherein, the patient had all the features consistent with sepsis.
**Two or more sets of blood cultures are recommended before initiation of any new antimicrobial in all patients with suspected sepsis.
***Hydroxyethyl starches (HESs) are not recommended for intravascular volume replacement in patients with sepsis or septic shock.
**** Norepinephrine is the first-choice vasopressor.