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Sepsis and septic shock
Sepsis is organ dysfunction caused by a dysregulated response to infection; treatment starts in the first hour — blood cultures, broad antibiotics, fluids for hypotension and noradrenaline to a MAP target of 65 — together with source control.
Why it matters in the exam
The exam asks about the Sepsis-3 definitions (a 2-point rise in SOFA; septic shock = a vasopressor needed for a MAP of 65 and lactate above 2 mmol/L despite fluids), what the first-hour treatment includes, how much fluid to give, which vasopressor comes first and when vasopressin and hydrocortisone are added. In anaesthesia it asks how a septic patient is anaesthetised for source-control surgery.
Under the 2021 guidelines lactate and blood cultures are taken, and broad antibiotics are given within an hour when there is shock or probable sepsis. For hypotension or a lactate of 4 or more, 30 mL/kg of crystalloid is given in the first hours, preferably balanced, and the response is reassessed. qSOFA alone is not recommended as a screening tool. If lactate is high it is measured again until it falls.
A septic patient coming to theatre is at high risk of collapse at induction: the vessels are relaxed, volume is short and the heart is depressed. So an arterial line and a vasopressor are prepared in advance, ketamine or etomidate at a reduced dose or a small slow dose of propofol is chosen, and RSI is used when there is an aspiration risk. Source control — drainage, removal of an infected line or surgery — is part of the treatment and must not be delayed.
Key points
- Sepsis = infection with organ dysfunction (SOFA rises by 2).
- Septic shock = vasopressor for a MAP of 65 and lactate above 2 despite fluids.
- First hour: lactate, cultures, antibiotics, 30 mL/kg, noradrenaline.
- Vasopressin and hydrocortisone in refractory shock.
- In anaesthesia: arterial line, vasopressor ready, reduced dose, source control.
Summary table
| Stage | What is done | Exam point |
|---|---|---|
| Definition | Sepsis: infection and a 2-point rise in SOFA; shock: vasopressor for a MAP of 65 and lactate above 2 mmol/L | qSOFA alone is not a recommended screening tool |
| First hour | Lactate, blood cultures, broad antibiotics | Antibiotics within an hour in shock |
| Fluids | 30 mL/kg balanced crystalloid, reassessment | Albumin when large volumes are needed |
| Vasopressors | Noradrenaline first; vasopressin as the dose rises; hydrocortisone 200 mg per day in refractory shock | Dobutamine or adrenaline for poor cardiac function |
| Anaesthesia for source control | Arterial line, vasopressor ready, ketamine or etomidate at a reduced dose | Do not delay source control |
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Sources
- Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), 2016 — Definitions
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock, 2021 — Initial resuscitation, antimicrobials, vasoactive agents
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.