To be measured within 3 hours
1. Draw Lactate: Measure lactate level
2. Draw Blood Cx: Obtain blood cultures prior to administration of antibiotics
3. Antibiotics: Administer broad-spectrum antibiotics
4. Fluids: Administer 30ml/Kg crystalloid for hypotension or lactate ≥ 4 mmol/L
5. Source control. Surgical source control when appropriate (e.g. appendicitis, abscess, etc).
To be completed within 6 hours
6. Vasopressors: Apply vasopressors (for hypotension that doesn’t respond to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) ≥ 65 mm Hg
7. In the event of persistent arterial hypotension despite volume resuscitation (septic shock) or initial lactate ≥ 4 mmol / L (36 mg/dL):
-Measure central venous pressure (CVP)*
-Measure central venous oxygen saturation (ScvO2)*
8. Draw Lactate: Remeasure lactate if initial lactate was elevated*
*Targets for quantitative resuscitation included in the guidelines are CVP of ≥ 8mm Hg, ScvO2 of ≥ 70%, and normalization of lactate.
** The 30ml/kg mentioned in the 3h bundle is given as a bolus. The 30ml/kg bolus is only applicable if there is hypotension or if lactate is > 4
“Broad-spectrum is defined as therapeutic agent(s) with sufficient activity to cover a broad range of gram negative and positive organisms and, if suspected, against fungi and viruses.” Uptodate.com
Source:
http://www.survivingsepsis.org/Bundles/Pages/default.aspx
https://www.uptodate.com/contents/evaluation-and-management-of-suspected-sepsis-and-septic-shock-in-adults