Quick SOFA (qSOFA) (Singer et al., 2016)

• Provides simple bedside criteria to quickly identify adult patients with suspected infection who are likely to have poor outcomes.
• Criteria 

• Respiratory rate ≥ 22/min
• Altered mental status
• Systolic blood pressure ≤ 100 mmHg  

Sepsis Management Bundles

• Within 3 hours of suspected sepsis (Society of Critical Care Medicine [SCCM], 2015):

• Measure lactate level.
• Obtain 2 sets of blood cultures prior to administration of antibiotics.
• Administer broad spectrum antibiotics (target within 1 hour of presentation).
• Administer 30 mL/kg crystalloid IV for hypotension or lactate ≥ 4 mmol/L.

• Within 6 hours of suspected sepsis (SCCM, 2015):

• Administer vasopressors (for hypotension that does not respond to initial fluid resuscitation) to maintain a MAP ≥ 65 mm Hg.
• Norepinephrine is first choice vasopressor.
• Add vasopressin (up to 0.03 U/min) or epinephrine, as needed to raise MAP to target.
• For persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate ≥ 4 mmol/L (36 mg/dL), reassess volume status and tissues perfusion and document findings:
• Repeat focused exam (after initial fluid resuscitation) including vital signs (heart rate, blood pressure, arterial oxygen saturation, respiratory rate, temperature, urine output, and others as available), as well as other noninvasive or invasive monitoring, as available.
• Perform additional hemodynamic assessment (such as assessing cardiac function) to determine type of shock if the clinical examination does not lead to a clear diagnosis.
• Perform dynamic assessment with passive leg raise to predict fluid responsiveness.
• Monitor lactate if initial lactate was elevated and target lactate to baseline level.