Shock

1/3 (SBP) + 2/3 (DBP)

SBP <90, or MAP <70

We want to restore at least 65 MAP in septic shock patients

30ml/kg of crystalloids for hypotension or lactate of >4mmol/L within 3 hours of sepsis identification

Crystalloids, NS or LR, LR is not the preferred choice

Start vasopressors

Norepinephrine (A1 and B1, raises vascular resistance and cardiac output)

Add vasopressin or epinephrine (vasopressin increases vascular resistance, epinephrine is similar to norepi but also stimulates B2 which lessens vascular resistance)

As an alternative to norepinephrine in specific populations (higher risk of tachyarrythmia so use in pts with bradycardia potentially)

If fluid and primary vasopressor therapy has failed

When patient is using vasopressors

IV hydrocortisone 200mg/day