If SBP is <90 mmHg and/or lactate is > or =4 mmol/L, give at least 30ml/kg of Normal Saline or Lactated Ringers (or more)in the first three hours or until lactate <4 mmol/L (repeated every 2-4 hours).
Blood cultures must be sent prior to the administration of broad spectrum antibiotics (or new antibiotics).
Administration of broad spectrum antibiotics must be done within 1 hour of the identification of severe sepsis or septic shock.
Completed by the First 6 Hours
If the MAP and SBP cannot be maintained with IV fluid alone, consider insertion of a CVL and start vasopressors (Levophed, Vasopressin, Dopamine: in that order) and titrate to a MAP > or = 65 or SBP > or = 90.
If there is a CVL, send SvO2 sat with a goal of >70% and CVP goal of 8-12 mmHg (or 12-15 mmHg of the patient is intubated and on the ventilator).
Repeat Lactate every 2-4 hours until <4 mmol/L or >10% reduction