Sepsis Management in the Emergency Department

Recognition and Risk Assessment

The Society of Critical Care Medicine recommends using the National Early Warning Score 2 (NEWS2) to evaluate the risk of severe illness or death from sepsis, with a score ≥7 indicating high risk requiring immediate intervention 3
The British Medical Journal suggests monitoring patients according to their risk level: high-risk patients every 30 minutes, moderate-risk patients every hour, and low-risk patients every 4-6 hours 3
The European Society of Intensive Care Medicine recommends performing a detailed patient history and thorough clinical examination to identify the source of infection 1

The American College of Critical Care Medicine recommends targeting adequate tissue perfusion as the principal endpoint of resuscitation, including normal capillary refill time, absence of skin mottling, warm extremities, and urine output >0.5 mL/kg/hour in adults 1, 2
The European Society of Intensive Care Medicine suggests administering at least 30 mL/kg of IV crystalloid fluid within the first 3 hours for sepsis-induced hypoperfusion, with aggressive infusion in the first 24-48 hours 1, 5

The Infectious Diseases Society of America recommends initiating sepsis treatment as early as possible with antimicrobials administered within 1 hour of recognizing sepsis 1, 2
The European Society of Clinical Microbiology and Infectious Diseases suggests administering intravenous antimicrobials at adequate dosages with a high likelihood to be active against suspected bacterial pathogens 1

The Society of Critical Care Medicine recommends using dopamine or epinephrine (adrenaline) in patients with persistent tissue hypoperfusion despite liberal fluid resuscitation 1
The American College of Critical Care Medicine suggests measuring arterial blood pressure and heart rate frequently in patients requiring vasopressors 1

The European Society of Intensive Care Medicine recommends applying oxygen to achieve an oxygen saturation >90%; if no pulse oximeter is available, administer oxygen empirically in patients with severe sepsis or septic shock 1, 2
The American Thoracic Society suggests placing patients in a semi-recumbent position (head of bed raised to 30-45°) 1

The World Society of Emergency Surgery recommends identifying and controlling the source of infection as soon as possible 6
The European Society of Intensive Care Medicine suggests draining or debriding the source of infection whenever possible 1

The Society of Critical Care Medicine recommends never leaving the septic patient alone; ensure continuous observation 2
The American College of Critical Care Medicine suggests performing clinical examinations several times per day 2

The British Medical Journal recommends that in remote and rural locations, patients assessed as high risk of severe illness or death from sepsis should receive antibiotics outside of hospital in accordance with local guidelines 3
The Infectious Diseases Society of America suggests considering higher risk of resistant pathogens if the infection was acquired in a healthcare setting, the patient has been hospitalized for more than 1 week, or has received previous antimicrobial therapy 4