1. Volume resuscitation (30 cc/kg IV saline/ LR w/ MAP goal 65 mmHg) 2. Source control and sampling 3. Broad spectrum abx 4. ± vasopressor support 1. norepinephrine 2. vasopressin 3. epinephrine Monitor: MAP (arterial line), central venous O2 (<70% ⇒heart failure), SIRS changes, lactic change for responses SIRS Temperature: > 38°C or < 36°C White blood cell count: > 12,000/mm3, < 4000/mm3, and/or > 10% band cells Heart rate: > 90/min Respiratory rate: > 20/min or PaCO2 < 32 mm Hg Sepsis - 2+ SIRS criteria with suspected/ confirmed infection source Severe sepsis - Sepsis + deranged perfusion pressure (e.g. ↗ lactic acid or ↗ shock index(HR/ SBP > 1)) Septic shock - unresolved severe sepsis after fluid and abx, or - frank hypotension (MAP < 65 mmHg) requiring vasopressor