Initial resuscitationThe initial evaluation of patients with sepsis includes the rapidestablishment of multiple points of intravenous (IV) accesswith anticipation for the need for fluid resuscitation, antimicrobials,and possibly vasoactive medications (vasopressors).As patients are often hypovolaemic, frequently suffering largefluid deficits, immediate administration of 30 mL/kg (typically2 L) of crystalloid is recommended.8,24 The goal is to restoretissue perfusion, and volume resuscitation leads to increasesin cardiac output and systemic oxygen delivery.24 Patients withhypotension (MAP <65 mmHg) after a fluid bolus, hyperlactatemia(>4 mmol/L), signs of hypoperfusion or organ failureare deemed to be in SS/SS. In such instances, transition to agoal-directed approach to therapy is recommended by consensusguidelines with measurable endpoints at the 3- and 6-hmarks.8 It is important to note that patients meeting criteriafor sepsis but not SS/SS may benefit from a similar approachto therapy. However, consensus guidelines advocating bundledcare pertain specifically to SS/SS patients.8In resource limited settings, administer at least 30 mL/kg(typically 2 L) of crystalloid upon the recognition of sepsis,as many patients are hypovolaemic.
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