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Sepsis 2026: Breaking Down the New Surviving Sepsis Campaign Guidelines

Protocol Update

Sepsis 2026: Breaking Down the New Surviving Sepsis Campaign Guidelines

What changed, why it matters, and how to implement in your ER today

The latest Surviving Sepsis Campaign guidelines represent the most significant update in five years. This comprehensive analysis breaks down the key changes in early recognition, fluid resuscitation strategies from the CLASSIC and CLOVERS trials, risk-stratified antibiotic timing, and vasopressor management—with practical implementation strategies for busy emergency departments.

Dr. Michael Torres, MD, FACEP

Emergency Medicine, Critical Care | Level I Trauma Center, Houston

•March 20, 2026

Latest Protocol Updates

Evidence-based guidelines with practical implementation strategies for your department

Stroke Code 2026: Extended Treatment Windows to 24 Hours

Protocol Update

Stroke Code 2026: Extended Treatment Windows to 24 Hours

DAWN and DEFUSE-3 trials redefined who benefits from mechanical thrombectomy. Updated protocols for advanced imaging selection, patient transfer decisions, and the new 24-hour treatment window.

Dr. Sarah Chen, MD, FAAN

Pediatric Fever 2026: Age-Based Risk Stratification

Protocol Update

Pediatric Fever 2026: Age-Based Risk Stratification

Step-by-Step algorithm for 29–60 day infants, updated SBI risk thresholds, and evidence-based guidance on when to obtain blood cultures, LP, and empiric antibiotics.

Dr. Emily Rodriguez, MD, FAAP

Trauma Resuscitation 2026: Damage Control & Massive Transfusion

Protocol Update

Trauma Resuscitation 2026: Damage Control & Massive Transfusion

PROPPR trial 1:1:1 ratios, whole blood resuscitation at 70% of Level I centers, TXA within 3 hours (CRASH-2/CRASH-3), REBOA Zone I/III deployment, and lethal triad management.

Dr. Marcus Williams, MD, FACS

All Protocol Articles — 7.5 CME Credits Total

Sepsis 2026: Surviving Sepsis Campaign Guidelines

Stroke Code 2026: Extended Treatment Windows

Pediatric Fever 2026: Age-Based Risk Stratification

Trauma Resuscitation 2026: Damage Control & MTP

QUICK REFERENCE

Clinical Decision Tools

High-yield scoring systems, dosing guides, and diagnostic criteria at a glance

NIHSS Stroke Scale

Neurology

·Level of consciousness (0–3)
·Gaze (0–2)
·Visual fields (0–3)
·Facial palsy (0–3)
·Motor arm/leg (0–4 each)
·Limb ataxia (0–2)
·Sensory (0–2)
·Language (0–3)
·Dysarthria (0–2)
·Extinction (0–2)

Clinical Note

Score ≥6: Consider thrombectomy. Score ≥4 + LVO: Transfer to CSC.

HEART Score for Chest Pain

Cardiology

·History: Highly suspicious = 2, Moderately = 1, Slightly = 0
·ECG: LBBB/ST changes = 2, Non-specific = 1, Normal = 0
·Age: ≥65 = 2, 45–64 = 1, <45 = 0
·Risk factors: ≥3 or hx atherosclerosis = 2, 1–2 = 1, None = 0
·Troponin: >3x normal = 2, 1–3x = 1, ≤normal = 0

Clinical Note

Score 0–3: Low risk (1.7% MACE). Score 4–6: Moderate. Score 7–10: High risk (50.1% MACE).

Sepsis-3 Criteria

Critical Care

·Suspected infection PLUS:
·SOFA score increase ≥2 points
·qSOFA (bedside): RR ≥22, AMS, SBP ≤100
·Septic shock: Vasopressor needed + Lactate >2 mmol/L despite adequate fluids

Clinical Note

Lactate >4 mmol/L = high mortality risk regardless of BP. Repeat lactate at 2 hours.

RSI Drug Dosing

Procedures

·Etomidate: 0.3 mg/kg IV (max 20mg)
·Ketamine: 1.5–2 mg/kg IV
·Propofol: 1.5–2 mg/kg IV (hemodynamically stable)
·Succinylcholine: 1.5 mg/kg IV
·Rocuronium: 1.2 mg/kg IV (sugammadex reversal)
·Pre-treat: Lidocaine 1.5 mg/kg for TBI

Clinical Note

Succinylcholine contraindicated: hyperkalemia, burns >24h, crush injury >72h, denervation.

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