Three in and three out, within one hour
Expansion
Three in
- Oxygen, titrated to target saturations
- Intravenous fluids, a balanced crystalloid bolus
- Intravenous antibiotics, broad spectrum, within 1 hour
Three out
- Blood cultures, before antibiotics where possible
- Lactate measurement
- Urine output monitoring, with a catheter if needed
“Give three, take three, within the hour.”
Definitions matter: sepsis is life threatening organ dysfunction caused by a dysregulated host response to infection, not simply infection with abnormal observations. Septic shock is sepsis with persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65 mmHg and a lactate above 2 despite adequate fluid resuscitation.
Screening uses NEWS2 in the UK; qSOFA (respiratory rate 22 or more, altered mentation, systolic 100 or less) is a bedside prompt rather than a screening tool, and it is insensitive early.
A lactate above 4 indicates high risk regardless of the blood pressure, and warrants critical care review.
Source control is the step most often forgotten: drain the abscess, remove the line, relieve the obstruction. Antibiotics alone will not treat an undrained collection.