Sepsis — 1-Hour Bundle (SSC)

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Recognize sepsis
   Suspected infection + acute organ dysfunction / hypoperfusion? (Sepsis = life-threatening organ dysfunction caused by infection. Bedside screening: qSOFA ≥2 (altered mentation, SBP ≤100, RR ≥22), rising SOFA or high NEWS2. Septic shock = vasopressors needed to maintain MAP ≥65 despite adequate fluids, plus lactate >2 mmol/L.)
   • Yes (suspected sepsis / septic shock) → Start the Hour-1 Bundle
   • No → Criteria not met → monitor
2. [End] Criteria not met → monitor
   Criteria for sepsis not yet met: actively find and treat the source of infection, give supportive care and monitor closely; reassess qSOFA/NEWS dynamically and start the Hour-1 bundle the moment it deteriorates.
3. [End] Start the Hour-1 Bundle
   Sepsis / septic shock is an emergency — start on recognition (do not insist everything is done within 1 h, but faster is better): 1) Measure lactate (recheck if initial >2 mmol/L). 2) Obtain blood cultures before antibiotics. 3) Give IV broad-spectrum empiric antibiotics immediately (per likely source and local resistance; as fast as possible, no delay). 4) Hypotension or lactate ≥4 mmol/L → rapid crystalloid 30 mL/kg (SSC: at least 30 mL/kg in the first 3 h, actual body weight, adjusted weight if BMI >30; assess fluid responsiveness dynamically to avoid overload). 5) Persistent hypotension during/after fluids → vasopressors (norepinephrine first-line, may start peripherally) to maintain MAP ≥65 mmHg. Also: source control; reassess and de-escalate antibiotics at 48–72 h.

Source guidelines & references

• Surviving Sepsis Campaign international guidelines 2021. Crit Care Med 2021 · source ↗
• SSC Hour-1 Bundle; Sepsis-3 definitions. JAMA 2016

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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