In the management of septic shock (Sepsis-3 definition), the SURVIVING SEPSIS CAMPAIGN (SSC) 2021 HOUR-1 BUNDLE requires completion of which actions within 1 hour of recognition?

• A Measure lactate; blood cultures; antibiotics; 10 mL/kg IV crystalloid; hydrocortisone
• B Blood cultures; 30 mL/kg IV crystalloid; vasopressors only after fluid resuscitation
• C Measure lactate; blood cultures; broad-spectrum antibiotics; 30 mL/kg IV crystalloid; vasopressors if MAP < 65 mmHg ✓
• D Immediate CT scan to identify source; then blood cultures and antibiotics

Explanation

The SSC 2021 Hour-1 Bundle (updated from prior 3-hour and 6-hour bundles) mandates the following within 1 hour of septic shock recognition: (1) measure lactate (re-measure if initial lactate >2 mmol/L); (2) obtain blood cultures BEFORE antibiotics; (3) administer broad-spectrum antibiotics; (4) administer 30 mL/kg IV crystalloid bolus for hypotension or lactate ≥4 mmol/L; (5) apply vasopressors (norepinephrine first-line) if MAP < 65 mmHg despite or during fluid resuscitation. Hydrocortisone is added for vasopressor-refractory shock, not universally.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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