Sepsis is a medical emergency.
“Time zero” or “time of presentation” is defined as the time of triage in ED or from earliest chart annotation consistent with all elements of sepsis or septic shock ascertained through chart review.
The Surviving Sepsis Campaign has recently updated the sepsis bundle. The most important change is that the 3-h and 6-h bundles have been combined into a single “hour-1” bundle. The intention is to begin resuscitation and management immediately rather than extending resuscitation measures over a longer period. More than 1 hour may be required for resuscitation to be completed, but the bundle should be initiated immediately.
Table. Hour-1 Surviving Sepsis Campaign Bundle of Care
NOTE: LACTATE – CULTURES – FLUIDS – ANTIBIOTICS – VASOPRESSORS
*re-measure lactate levels within 2-4 hours.
Table below calculates the amount of fluid resuscitation based on KgBW (at 30cc/Kg). Notice that for every 100 Kg of body weight, 3 liters of crystalloids should be given for fluid resuscitation of septic patients.
Here is the cheat sheet for Sepsis Bundle from LHH:
*Note that our sepsis bundle cheat sheet has not yet been updated to reflect the most recent Surviving Sepsis Campaign guideline updates.
Levy, M., Evans, L. and Rhodes, A. (2018). The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Medicine.
Lenox Hill Hospital Severe Sepsis / Septic Shock Management Bundle.