Sepsis · Hour 1

Time since recognition
0:00
0 of 5 bundle items complete
≈ 154.3 lb
30 mL/kg bolus
2,100 mL
Norepi start (0.05 mcg/kg/min)
3.5 mcg/min
Empiric broad-spectrum antibiotics

Give within 1 h of recognition. Choose β-lactam ± vancomycin based on source & local antibiogram. Renally adjust subsequent doses.

4.5 g IV (extended infusion over 4 h)
Pseudomonal coverage; preferred broad-spectrum β-lactam.
2 g IV q8h
Alternative if pip-tazo unavailable or recent exposure.
1 g IV q8h (2 g if CNS source / severe)
Use for ESBL risk, neutropenia, or prior resistant organisms.
1,750 mg IV load (25 mg/kg, max 3 g)
Add for MRSA risk, indwelling lines, skin/soft tissue, pneumonia.
Source-specific add-ons
2 g IV q24h
Community-acquired pneumonia, urinary, meningitis (give 2 g q12h for CNS).
Azithromycin
500 mg IV q24h
Atypical coverage with CAP / severe pneumonia.
500 mg IV q8h
Anaerobic coverage for intra-abdominal source if not on pip-tazo / carbapenem.
Acyclovir
700 mg IV q8h (10 mg/kg)
Add for suspected HSV encephalitis.
Vasopressors (target MAP ≥ 65)

Start once euvolemic / mid-resuscitation if MAP < 65. first; add then if escalating.

(1st line)
Start 3.5 mcg/min (0.05 mcg/kg/min)
Titrate 0.01–1 mcg/kg/min for MAP ≥ 65
Central line preferred; peripheral OK short-term in large vein.
Vasopressin (add-on)
0.03 units/min fixed infusion
No titration; add when on norepi ≥ 0.25 mcg/kg/min
Catecholamine-sparing; do not use as monotherapy.
Start 3.5 mcg/min (0.05 mcg/kg/min)
Titrate 0.01–1 mcg/kg/min
Add 3rd or use if norepi-refractory / cardiogenic component.
Start 40–60 mcg/min
Titrate 0.5–6 mcg/kg/min
Consider in tachyarrhythmia where catecholamines undesirable.
Adjuncts: hydrocortisone 50 mg IV q6h if on ≥ 0.25 mcg/kg/min for ≥ 4 h. Re-check lactate, MAP, and end-organ perfusion q15–30 min during titration.
Resuscitation targets
  • MAP ≥ 65 mmHg
  • Urine output ≥ 0.5 mL/kg/hr (35 mL/hr)
  • Lactate clearance / normalization
  • Reassess volume status after each bolus (POCUS, passive leg raise)
Source control
  • Imaging to localize source within 6 h if possible
  • Drain abscess / debride / remove infected lines as soon as feasible
  • Consider surgery / IR / GU consult early

Educational aid only — verify against local sepsis protocol.