ICU Map

Fever / Suspected Sepsis

From recognizing organ dysfunction to source identification and time-sensitive empiric therapy.

RecognizeAssessDecideDifferentialInterveneReassess
Fever / Suspected Sepsis
Assessment StepConfirm the fever and assess severity
Temperature plus the full vital sign set — heart rate, respiratory rate, blood pressure, and mentation.
Diagnosis / EtiologyScreen for organ dysfunctionExplore Topic
Altered mentation, hypotension, tachypnea, and a rising lactate — organ dysfunction is what separates sepsis from simple infection.
Assessment StepIdentify a likely source
Focused exam and history — lungs, urinary tract, abdomen, skin/soft tissue, and any indwelling line or device.
Assessment StepObtain cultures before antibiotics, without delaying therapy
Two sets of blood cultures plus other site-specific cultures as indicated — but never let culture collection delay the first antibiotic dose.
Clinical ActionStart empiric therapy within the first hourExplore Topic
Broad-spectrum antibiotics targeted to the likely source, plus fluid resuscitation if hypotensive or hypoperfused.
Reassessment / LoopReassess at 3–6 hours
Repeat vitals, lactate clearance, and urine output to judge the response to initial therapy.
Differential Branches (2)
1Branch
Reassessment / LoopResponding
Continue source-directed therapy, narrow antibiotics once culture data returns, and de-escalate monitoring as appropriate.
2Branch
Reassessment / LoopNot responding / worseningExplore Topic
Escalate: reassess source control, start vasopressors if not already on board, and move to ICU-level monitoring.

An educational representation of clinical reasoning, not a diagnostic algorithm or personalized medical advice — always apply clinical judgment and institutional protocols.

Caution

Escalate — Red Flags & Critical Warnings

  • Hypotension refractory to an initial fluid bolus — start vasopressors promptly rather than continuing large-volume fluid resuscitation alone.
  • A source amenable to drainage or debridement (abscess, empyema, necrotizing infection) — antibiotics alone will not control it; escalate for procedural or surgical source control.

Related Bedside Clinical Problems (21)

Bedside Presentations
Acute Hypotension & Undifferentiated Shock

Rapid bedside hemodynamic categorization: confirming MAP < 65 mmHg, assessing peripheral perfusion, POCUS cardiac/IVC profiling, and differentiating hypovolemic, distributive, cardiogenic, and obstructive etiologies.

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Refractory Shock Despite High-Dose Vasopressors

Advanced multimodal hemodynamic rescue: second-line vasopressors (vasopressin, angiotensin II), inotropic augmentation, stress-dose steroids, metabolic correction, and mechanical circulatory support evaluation.

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New Tachycardia & Tachyarrhythmias

Algorithmic triage of acute heart rates > 100–150 bpm: stability screen (immediate cardioversion if unstable), narrow vs wide QRS differentiation, Brugada VT rules, and sinus tachycardia etiology search.

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Linked Deep-Dive Topics (8)

Reference Knowledge
Sepsisinfectious-disease

Life-threatening organ dysfunction caused by a dysregulated host response to infection — recognized by an acute rise in SOFA score, not by infection plus fever alone.

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Septic Shockcardiovascular

The subset of sepsis with profound circulatory and cellular/metabolic abnormality — clinically identified by a vasopressor requirement to maintain MAP ≥ 65 mmHg plus lactate > 2 mmol/L despite adequate fluid resuscitation.

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Multidrug-Resistant (MDR) Pathogens & IDSA AMR Guidanceinfectious-disease

Molecular resistance mechanisms (ESBL, AmpC, KPC, NDM, OXA-48, DTR-Pseudomonas, CRAB), the MERINO trial, and modern novel beta-lactamase inhibitor therapeutics.

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Necrotizing Soft Tissue Infections (NSTI)infectious-disease

A surgical source-control emergency: recognize rapidly progressive deep infection, involve surgery immediately, start broad antimicrobials, resuscitate shock, and re-explore until source control is complete.

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Hospital-Acquired Pneumonia (HAP)infectious-disease

Nosocomial pneumonia developing ≥ 48 hours after admission in non-ventilated patients, host and antibiogram MDR risk tailoring, nasal MRSA PCR screening, and 7-day de-escalation.

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Ventilator-Associated Pneumonia (VAP)infectious-disease

Quantitative lower tract sampling (ETA vs BAL), rapid multiplex PCR panels and stewardship interpretation, PK/PD extended beta-lactams, 7-day duration, and the SHEA prevention bundle.

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Acute Meningitis & Encephalitisneurology

CT-before-LP criteria, CSF interpretation matrix, de Gans Dexamethasone timing, empiric age/host antimicrobial coverage + Ampicillin + Acyclovir, and neurocritical ICP management.

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Shock: Foundational Critical Care Frameworkcardiovascular

Cellular dysoxia, DO2/VO2 physiology, the 4 shock phenotypes, dynamic fluid responsiveness (PLR/PPV) vs fluid tolerance (VExUS), and vasoactive pharmacology.

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