Suspected sepsis in an adult
Acute illness or deterioration that may be due to infection. Sepsis = infection with new organ dysfunction.
All Pathways
Emergency MedicineEmergency
Sepsis & Septic Shock Management (Surviving Sepsis 2026)
Sepsis & Septic Shock Management (Surviving Sepsis 2026): Suspected sepsis in an adult → Child, pregnancy or neutropenia: use a specific pathway → Shock...
Pathway Overview
18 steps
Algorithm Steps
18 total
01Start 02Warning Child, pregnancy or neutropenia: use a specific pathway
This pathway is for non-pregnant adults.
- Child or adolescent: use a paediatric sepsis pathway (criteria, fluid volumes and doses differ)
- Pregnant or up to 6 weeks after birth: use a maternal sepsis pathway and involve obstetrics now
- Neutropenia or recent chemotherapy: follow the local febrile neutropenia protocol
03Decision Shock, or sepsis probable?
Shock: MAP below 65 mmHg, mottled or ashen skin, altered mentation or raised lactate. Probable sepsis: infection likely with new organ dysfunction.
- Screen with NEWS2, MEWS or SIRS; do not use qSOFA alone
- Sepsis is a clinical diagnosis: no single test rules it in or out
- Possible sepsis: infection is one of several causes and no shock
- If Yes
04Action Shock or probable sepsis: treat now
Start treatment and resuscitation at once. Antimicrobials within 1 h of recognition.
- Monitor BP, heart rate, respiratory rate and conscious state at least hourly
- Measure lactate and capillary refill time within 1 h
- Long-term corticosteroids or adrenal insufficiency: hydrocortisone 100 mg IV now; do not wait for vasopressor thresholds
- Senior clinician review now; ICU review if shock
- Do not wait for ICU admission to start treatment
05Action Blood cultures before antimicrobials
Take 2 sets as soon as possible, but do not delay antimicrobials to get them.
- Other samples by likely source (urine, sputum, wound)
- Patient to be transferred: take cultures and give the first dose before transfer
06Action Start empirical antimicrobials
Shock or probable sepsis: within 1 h. Possible sepsis: within 3 h if concern persists. Check allergy history first. On long-term corticosteroids or adrenal insufficiency: also give hydrocortisone 100 mg IV now.
- Choose by likely source: Therapeutic Guidelines (eTG) and local antibiogram
- Cover MDR organisms (e.g. MRSA) only if high risk: known colonisation, prior infection, long broad-spectrum use
- Beta-lactams: loading dose, then prolonged infusion
- Penicillin allergy: follow eTG allergy advice; ID advice if unsure
- Review at least daily; de-escalate when culture results are available
07Decision Hypotension or raised lactate?
Signs of sepsis-induced hypoperfusion: MAP below 65 mmHg or lactate above 2 mmol/L.
- If Yes
08Action Hypoperfusion: IV crystalloid boluses, reassess after each
Give 500 mL boluses. Hypotension or lactate 4 mmol/L or more: aim for at least 30 mL/kg within 3 h (weak recommendation). Lactate 2-4 mmol/L with normal BP: bolus and reassess. Heart failure, dialysis or fluid overload: smaller boluses and start noradrenaline early. Head injury: use 0.9% saline, no albumin.
- Balanced crystalloid (Hartmann's or Plasma-Lyte 148) preferred over 0.9% saline
- Reassess after each bolus: BP, heart rate, capillary refill, lung signs
- Dose by actual body weight; if BMI above 30 kg/m2, use adjusted or ideal body weight
- More fluid only if fluid-responsive (passive leg raise or bolus response)
- Trend lactate; stop fluids when it falls, do not chase a normal value
- Cirrhosis or large crystalloid volumes: consider albumin (not in head injury)
- Do not give antibiotics (e.g. ceftriaxone) with Hartmann's at the same time in one line; flush before and after
- Do not use starches or gelatin
09Decision Hypotension despite fluids?
MAP below 65 mmHg during or after initial fluid. Unstable shock: start noradrenaline with fluids; do not wait.
- If Yes
10Action Septic shock: start noradrenaline (norepinephrine)
Target MAP 65 mmHg (60-65 mmHg if 65 years or older). Start via a peripheral line; do not wait for central access. On long-term corticosteroids or adrenal insufficiency: hydrocortisone now if not given.
- Peripheral line: in or above the antecubital fossa, short-term only; check the site often; arrange central access if ongoing need
- Rising noradrenaline dose, usually at 0.25-0.5 microgram/kg/min: add vasopressin (off-label in Australia)
- MAP still below target: add adrenaline
- Ongoing noradrenaline need: IV hydrocortisone 200 mg/day (50 mg every 6 h), with or without fludrocortisone; usually at 0.25 microgram/kg/min or more for at least 4 h
- Cardiac dysfunction with poor perfusion: add dobutamine or use adrenaline
- Do not use dopamine
- Arterial line if vasopressor doses are high or rising
11Action Find and control the source
Look quickly for a source that needs a procedure. Control it early, ideally within 6 h of diagnosis.
- Imaging as needed (ultrasound, CT)
- Drain abscesses; debride necrotic tissue
- Remove infected lines or devices
- Early surgical or interventional radiology referral
12Action Escalation and ongoing care
Shock, vasopressors or organ support: ICU admission, ideally within 6 h.
- Others: close ward monitoring with a clear escalation plan
- Review antimicrobials daily with culture results
- Discuss goals of care early (within 72 h)
13Decision Improving with treatment?
Perfusion, lactate, BP and organ function.
- If Yes
14Outcome Improving: continue and de-escalate
Narrow or stop antimicrobials by culture results; use the shortest effective course. Plan follow-up.
If No15Outcome Not improving: refractory shock, ICU consultant now
Check source control and other causes of shock. Add hydrocortisone if not given. Discuss goals of care.
If No16Action No hypotension: reassess often
Reassess perfusion at least hourly until stable.
- Trend lactate if it was raised
- Capillary refill time, mental state, urine output
- Hypotension or rising lactate: give fluid and start noradrenaline
- Path rejoins step 11Shared downstream outcome
If No17Action No hypoperfusion: fluids as needed
No fixed bolus. Give fluid as clinically needed and reassess perfusion often.
- If hypotension or raised lactate develops, give crystalloid boluses with reassessment
- Path rejoins step 09Shared downstream outcome
If No18Action Possible sepsis, no shock: rapid assessment
Look for infective and non-infective causes. If concern for infection persists, give antimicrobials within 3 h of first suspicion.
- Measure lactate
- Low likelihood of infection: defer antimicrobials and monitor closely
- Re-screen often; if shock or organ dysfunction develops, treat within 1 h
- Path rejoins step 05Shared downstream outcome
Guideline Source
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Adults only. Not for children, pregnancy or up to 6 weeks after birth, or febrile neutropenia: use a specific pathway.
- No empirical antimicrobial regimen or doses: use Therapeutic Guidelines (eTG) and the local antibiogram.
- The 30 mL/kg fluid volume is a weak recommendation; individualise in heart failure, dialysis-dependent kidney failure, cirrhosis and ARDS.
- Source control procedures, ventilation and ICU organ support are not covered in detail.
- Does not replace clinical judgement.
Contraindicated Populations
pediatricneonatalpregnancy and up to 6 weeks postpartum (maternal sepsis criteria differ)
Applicable Regions
AUUSEUInternational
AU: ACSQHC Sepsis Clinical Care Standard (2022): use a locally approved sepsis pathway; antimicrobials within 60 minutes of recognising infection-related organ dysfunction. Empirical choice per Therapeutic Guidelines (eTG) and local antibiogram. Argipressin (vasopressin) for septic shock is off-label in Australia.
EU: Local antibiograms vary; use national or local antimicrobial guidance.
US: CMS SEP-1 quality measure reporting may apply; follow local documentation rules.
International: Resource-limited settings may need modified approaches.
Version 2Next review: 2027-09-30
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the Sepsis & Septic Shock Management (Surviving Sepsis 2026)?
The Sepsis & Septic Shock Management (Surviving Sepsis 2026) is a emergency clinical algorithm for Emergency Medicine. It provides a structured decision tree to guide clinical decision-making, based on Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026.
What guideline is the Sepsis & Septic Shock Management (Surviving Sepsis 2026) based on?
This algorithm is based on Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026 (DOI: 10.1097/CCM.0000000000007075).
What are the limitations of the Sepsis & Septic Shock Management (Surviving Sepsis 2026)?
Known limitations include: Adults only. Not for children, pregnancy or up to 6 weeks after birth, or febrile neutropenia: use a specific pathway.; No empirical antimicrobial regimen or doses: use Therapeutic Guidelines (eTG) and the local antibiogram.; The 30 mL/kg fluid volume is a weak recommendation; individualise in heart failure, dialysis-dependent kidney failure, cirrhosis and ARDS.; Source control procedures, ventilation and ICU organ support are not covered in detail.; Does not replace clinical judgement.. Individual patient factors may require deviation from these recommendations.
Get AI-Powered Analysis Alongside This Algorithm
In AttendMe.ai, the Sepsis & Septic Shock Management (Surviving Sepsis 2026) appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.
Try AttendMe Free