Guidelines
Septic Shock

Septic Shock

Clinical Pearls

Blood cultures before antibiotics (unless there is a significant delay)

IV antibiotics should be started within first hour of clinical signs of sepsis or septic shock

Definitions

Suspected infection AND at least 2 of:

  • Altered mental status

  • RR ≥22 breaths/min

  • SBP ≤100 mmHg (qSOFA)

  • Signs of organ dysfunction

Sepsis AND

  • Persisting hypotension OR

  • Lactate >2 mmol/L despite a fluid bolus

Known Source

Treat as per empiric guidelines

Unknown Source - First Line

  • Consider 4.5g if P. aeruginosa suspected

AND

THEN

  • Dosing recommendations are based on 70kg patient with normal renal function; (recommended dose 15-20 mg/kg/dose unless otherwise stated)

  • Please contact pharmacy for patients requiring vancomycin or aminoglycoside monitoring

+/-

Unknown Source - Second Line

THEN

  • Dosing recommendations are based on 70kg patient with normal renal function; (recommended dose 15-20 mg/kg/dose unless otherwise stated)

  • Please contact pharmacy for patients requiring vancomycin or aminoglycoside monitoring

AND

+/

Tailor Therapy

  • On Day 3 or when culture and susceptibility results are available, tailor antimicrobial therapy to pathogen.

  • See: www.survivingsepsis.org