Essential components of the ED management of sepsis include early identification, antibiotics ASAP, fluid resuscitation, and maintaining adequate perfusion pressure.
If patients continue to have evidence of shock (i.e. high lactate) despite adequate fluids and/or pressors, strongly consider intubation, even in the patient without acute respiratory decompensation.
The respiratory muscles are avid consumers of oxygen and can use up to 50% of circulating O2.
Intubation and paralysis not only increase available O2 to vital organs, it can also augment cardiac output for patients with persistent septic shock.
