A Comprehensive Review for Sepsis and Septic Shock Management in The Emergency Room

Abstract

Sepsis and septic shock are life-threatening conditions characterized by organ dysfunction resulting from a dysregulated host response to infection. The management of septic patients represents a significant challenge for emergency physicians, as early recognition and prompt initiation of treatment are crucial for improving patient outcomes. This narrative review provides an updated and comprehensive overview of the pathophysiology and management of septic shock, focusing on recent advancements and practical implications for emergency physicians. The review discusses the hemodynamic alterations in septic shock, including macrocirculatory and microcirculatory derangements, and their impact on oxygen delivery and tissue perfusion. The cornerstone of initial treatment for septic shock patients is fluid therapy, and the review explores the current debates surrounding fluid volume, choice of fluids, and the use of dynamic tests to guide fluid responsiveness. The early administration of vasopressors, particularly norepinephrine, is also highlighted as a key intervention to counteract the severely impaired arterial tone in septic shock. The review emphasizes the importance of timely antimicrobial therapy, discussing the timing of administration, selection of appropriate agents, and considerations for dosing in the emergency department setting. Additionally, the potential roles of adjunctive therapies, such as corticosteroids, ascorbic acid, and thiamine, are examined in light of recent clinical trials and meta-analyses. The review concludes by stressing the importance of a systematic approach to the early identification and management of septic patients in the emergency department, tailored to the specific characteristics of each patient, to reduce mortality and improve outcomes.