In a post-operative patient developing SIRS with suspected early sepsis, the Surviving Sepsis Campaign 2021 hour-1 bundle includes which combination of interventions?

• A Urinalysis and CBC; hold antibiotics until cultures return; 10 mL/kg IV bolus; norepinephrine if BP unresponsive after 2 hours
• B CT scan to identify source; administer antibiotics after source confirmation; 20 mL/kg balanced crystalloid
• C Start hydrocortisone immediately; measure procalcitonin; administer antibiotics within 3 hours
• D Measure lactate; blood cultures before antibiotics; administer broad-spectrum antibiotics; 30 mL/kg IV crystalloid if hypotensive or lactate ≥4 mmol/L; vasopressors for MAP <65 mmHg ✓

Explanation

The Surviving Sepsis Campaign 2021 hour-1 bundle (updated from the 3-hour and 6-hour bundles) includes: (1) measure lactate—if >2 mmol/L, remeasure; (2) obtain blood cultures before antibiotics; (3) administer broad-spectrum antibiotics within 1 hour of recognition; (4) administer 30 mL/kg IV crystalloid bolus if hypotensive (MAP <65 mmHg) or lactate ≥4 mmol/L; (5) start vasopressors (norepinephrine is first-line) to maintain MAP ≥65 mmHg if unresponsive to fluids. Hydrocortisone is reserved for septic shock refractory to vasopressors, not first-line.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.