In summary, severe sepsis and septic shock are medical emergencies that affect hundreds of thousands of individuals annually and result in death in about one third of these patients. Severe sepsis and septic shock are disease processes that require aggressive, time sensitive interventions, which has lead to the adoption of the practice of early-goal directed therapy and other aspects of bundled sepsis care in emergency departments internationally (Table2). Since the inception of this concept of early aggressive management of the septic patient, many advances have occurred to help further the care of these patients. Advances in methods for hemodynamic monitoring, the use of appropriate antimicrobial therapy, more sophisticated understanding of the risks and benefits of aggressively controlling glucose levels, choice of vasopressor therapy, and the utility of steroid implementation in the septic patient have lead to significant improvement in patient care. Despite controversy with regard to implementation and utilization of the Surviving Sepsis Campaign recommendations, emergency departments that have been compliant with the guidelines have seen significant improvement in their outcomes and more survivors. In summary, severe sepsis is a time critical disease, and therefore, one of significant concern to the emergency medicine physician.