Management of sepsis and septic shock in the emergency department

Abstract

Early management of sepsis and septic shock is crucial for patients' prognosis. As the Emergency Department (ED) is the place where the first medical contact for septic patients is likely to occur, emergency physicians play an essential role in the early phases of patient management, which consists of accurate initial diagnosis, resuscitation, and early antibiotic treatment. Since the issuing of the Surviving Sepsis Campaign guidelines in 2016, several studies have been published on different aspects of sepsis management, adding a substantial amount of new information on the pathophysiology and treatment of sepsis and septic shock. In light of this emerging evidence, the present narrative review provides a comprehensive account of the recent advances in septic patient management in the ED.

Keywords: Antibiotic therapy; Emergency medicine; Fluid resuscitation; Preload responsiveness; Vasopressors.

Fig. 1

Clinical criteria for sepsis and septic shock definition. Adapted from [1]. SOFA Sequential Organ Failure Assessment, qSOFA quick-SOFA

Fig. 2

DO₂/VO₂ relationship in patients with or without septic shock. CaO₂ arterial oxygen content, CO cardiac output, CvO₂ venous oxygen content, DO₂ oxygen delivery, Hb hemoglobin, OER oxygen extraction ratio, paO₂ arterial partial pressure of oxygen, pvO₂ venous partial pressure of oxygen, SaO₂ arterial oxygen saturation, ScvO₂ central venous oxygen saturation, SvO₂ mixed venous oxygen saturation, VO₂ oxygen consumption