Patient handout

Sepsis / septic shock

PRODUCTION

1. Your condition

This handout is for sepsis / septic shock. Your care team identified this based on: suspected infection + organ dysfunction (qsofa ≥2 / news2 ≥5 / sirs; sepsis-3 singer jama 2016).

Other reasons your team may use this plan: hypotension with suspected infection (sepsis-3 singer jama 2016); lactate >2 with infection (ssc 2026); positive blood culture (ssc 2026).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
norepinephrine	—	—	—	SSC 2026 first-line strong; less arrhythmogenic than dopamine (SOAP-II)
vasopressin	—	—	—	SSC 2026 conditional add-on to spare NE dose (VANISH/VASST)
epinephrine	—	—	—	SSC 2026 third-line + cardiac dysfunction component
phenylephrine	—	—	—	Pure alpha when arrhythmias limit catecholamines (SSC 2026 conditional)
hydrocortisone	—	—	—	SSC 2026 conditional 200 mg/d divided; STRESS-L timing

Plan: Vasoactive titration in septic shock (SSC 2026)

3. When to call your provider

Contact your care team if any of the following happen:

New fever / chills / rigors → ED for recurrent-sepsis workup (SSC 2026)
Worsening cognition / agitation / new neurologic deficit → ED (SSC 2026)
Functional decline below pre-admission baseline → urgent PCP visit + rehab referral (SSC 2026)
Source-site signs of relapse (productive cough, dysuria, abdominal pain, wound drainage) → urgent PCP visit + targeted workup (SSC 2026)
PHQ-9 ≥15 OR suicidal ideation → mental health urgent referral (PHQ-9 standard cutoff; routes to psych.depression.core.v1 / psych.suicidality.ed.core.v1)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Suspected/confirmed infection + SOFA score increase ≥2 from baseline = sepsis (Sepsis-3 Singer JAMA 2016)
Persistent MAP <65 requiring vasopressors AND lactate >2 despite adequate fluid resuscitation = septic shock (Sepsis-3 Singer JAMA 2016; SSC 2026)(life-threatening)
Initial lactate >4 mmol/L OR <10% clearance per hour after Hour-1 bundle (SSC 2026)
ANC <500 + temperature ≥38.3°C (or sustained ≥38.0°C; IDSA 2024 febrile neutropenia)
Surgical / interventional source (abscess, perforation, obstruction, infected device) not addressed within 6-12 h (SSC 2026 strong recommendation)
Sepsis + KDIGO stage 2-3 AKI (creatinine ≥2× baseline OR UOP <0.5 mL/kg/h ≥12 h; KDIGO 2026)
Sepsis with central line in place + differential time-to-positivity blood cultures positive earlier from line vs peripheral (Mermel IDSA CRBSI 2009)
New dysfunction in ≥3 organ systems (SOFA Δ ≥1 each across 3+ of: respiratory, cardiovascular, hepatic, coagulation, renal, neurologic) within 24 h of sepsis recognition (Sepsis-3 Singer JAMA 2016; SSC 2026)(life-threatening)
Empiric broad-spectrum antibiotic NOT administered within 1 h of septic-shock recognition OR within 3 h of possible-sepsis (without shock) recognition (SSC 2026 Hour-1 bundle; Kumar CCM 2006)

5. Follow-up

Post-sepsis goals-of-care discussion (SSC 2026 emphasis); PICS screen at 1-3 months; cognitive / functional rehab; review and de-escalate abx; outpatient ID f/u for endocarditis / osteomyelitis when present

6. Sources

Guideline: Surviving Sepsis Campaign 2026 (Crit Care Med + Intensive Care Med, March 2026) + SSC 2021 (Evans CCM 2021) + Sepsis-3 (Singer JAMA 2016) + SEPSISPAM (Asfar NEJM 2014 — MAP target) + OVATION-65 (Lamontagne JAMA 2020 — permissive hypotension in ≥65 yo) + CLOVERS (Shapiro NEJM 2023 — restrictive vs liberal fluid) + ANDROMEDA-SHOCK (Hernández JAMA 2019 — peripheral perfusion) + balanced crystalloid trials (SMART/BaSICS/PLUS) + APROCCHSS (Annane NEJM 2018) + ADRENAL (Venkatesh NEJM 2018) + VASST (Russell NEJM 2008)