Updates and Controversies in the Early Management of Sepsis and Septic Shock (Infectious Disease CME and Pharmacology CME)

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Delivery Method:	Online
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Publication Date: August 2025 (Volume 27, Number 8)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 08/01/2028.

Specialty CME Credits:Included as part of the 4 credits, this CME activity is eligible for 2 Infectious Disease and 2 Pharmacology CME credits, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Sepsis is a common life-threatening condition that requires early recognition and prompt management. Diagnosis and treatment of sepsis and septic shock are fundamental for emergency clinicians. Optimal sepsis management includes prompt identification of early signs of sepsis and septic shock, hemodynamic optimization, knowledge of clinical and laboratory indicators of subtle and overt organ dysfunction, and prompt infection source identification and control. This structured review summarizes and evaluates the most recent literature on the management of sepsis, focusing on the current evidence, guidelines, and protocols.

Case Presentations

A 40-year-old woman with no past medical history presents with 3 days of fever, chills, dysuria, and flank pain…

• Her initial vital signs on ED triage are: temperature, 38.5°C; heart rate, 120 beats/min; blood pressure, 135/82 mm Hg; respiratory rate, 18 breaths/min; and oxygen saturation, 95% on room air.
• She is speaking in full sentences, demonstrating normal mentation, and is not in respiratory distress. Her lungs are clear to auscultation. Her abdomen is soft and minimally tender over the suprapubic region without rebound or guarding, with right costovertebral angle tenderness. She has brisk capillary refill. The patient has no recent hospitalizations.
• You believe she looks clinically well, but you wonder how concerned you should be about sepsis…

A 63-year-old man with a past medical history of right knee replacement 3 months ago, diabetes mellitus, and hypertension presents to the ED with fever, cough, and dyspnea…

• His initial vital signs are: temperature, 38.5°C; heart rate, 112 beats/min; blood pressure, 102/68 mm Hg; respiratory rate, 22 breaths/min; and oxygen saturation, 93% on room air.
• He is alert, but thinks it is 1997 and that Bill Clinton is the United States president. Physical examination reveals rales at the left lung base, no wheezing or respiratory distress, tachycardia, a benign abdomen, and well-healing surgical incisions.
• Laboratory findings include WBC of 14 ×10³/mm³ with 5% bandemia, platelet count of 130 ×10³/mm³, creatinine of 1.5 mg/dL (baseline of 0.85 mg/dL), and serum lactate of 2.5 mmol/L.
• Chest radiograph confirms left lower lobe infiltrate. After receiving ibuprofen and acetaminophen, the patient feels much better and requests to be discharged. His confusion has now resolved; he is oriented to person, place, time, and situation. The nurse asks whether she can remove the IV for the patient to be discharged, but something worries you…

A 35-year-old man with a past medical history of poorly controlled diabetes mellitus and IV drug use presents to the ED for right axillary pain and swelling…

• The paramedics report that he frequently presents for poorly controlled diabetes. He continues to complain of “20/10” pain despite 150 mcg of prehospital IV fentanyl. Prehospital vital signs include: temperature, 39.4°C; heart rate, 135 beats/min; blood pressure, 82/52 mm Hg; respiratory rate, 30 breaths/min; and oxygen saturation, 88% on room air. His initial glucose level is 342 mg/dL.
• The patient is alert and oriented but screaming in pain as he is transferred from the EMS stretcher. Physical examination reveals tachycardia; delayed capillary refill to 4 seconds; tachypnea; clear breath sounds; and erythema, swelling, and crepitus overlying the right axilla and chest wall.
• After 2 liters of isotonic crystalloid administration by EMS, repeat blood pressure is 70/45 mm Hg. You consider the best antibiotic(s) and are uncertain whether you should initiate vasopressors now, attempt another fluid bolus, or do both simultaneously…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.