Management: Academy of Medical Royal Colleges (AoMRC): NEWS ≥ 7: immediate antibiotics and microbial investigations (within an hour) (in children: NEWS ≥ 9, shock or if child appears unwell to a health professional) NEW 5-6: 3-4 hour window for microbial investigations to clarify the diagnosis before antibiotics need to be given Surviving Sepsis:

1-hour target of antibiotic administration: if shocked and sepsis likely or possible, or not shocked but sepsis likely

3-hours target of investigation to : if if not shocked and sepsis possible to investigate Blood culture +/- eg swab/sample pre antibiotics Serum lactate (serial measurement as predictor of severity/survival) Hourly urine output

IV antibiotics (as per working diagnosis and local guidelines, if meningococcal disease is specifically suspected (fever and purpuric rash) parenteral benzylpenicillin or third-generation cephalosporin) Oxygen to maintain SpO2 > 94% (88-92% if at risk of CO2 retention)

IV fluid resuscitation if hypotensive, lactate > 2 mmol/l or acute kidney injury - Adult: 500 ml IV crystalloid stat and assess response (30 ml/kg in the first three hours for an adult with septic shock acc to Surviving Sepsis

- Child: 20 ml/kg IV crystalloid over 10 mins and assess response