Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection (Sepsis-3 definition, adopted by Surviving Sepsis Campaign in 2017).1

Septic Shock: Persistent hypotension requiring vasopressors to maintain mean arterial pressure (MAP) > 65 mmHg and having a serum lactate > 2 mmol/L despite adequate volume resuscitation.

Shock is one of the most common complications of severe injury or illness. Shock is separated into four different classes: 1) hypovolemic (including hemorrhagic), 2) cardiogenic, 3) obstructive, and 4) distributive. Septic shock is a form of distributive shock. The hallmark of managing shock is:

1. early recognition (including an awareness that the magnitude of injury or illness has the potential to lead to shock);
2. identification of the cause of shock; and
3. early, decisive treatment of the cause and initiation of cause-specific resuscitation.

Severe infection is often a greater risk than trauma in the PFC environment. Trauma-associated sepsis is an important subset of sepsis in the military population, with a potential for casualties to develop severe wound, respiratory, urinary, and bloodstream infections related to their initial injury and initial treatment procedures (IV/IO catheters, foley catheters, etc.). Up to 38% of trauma-related sepsis is bloodstream-related.2 In the trauma patient, the manifestation of sepsis is often several days after initial presentation which makes sepsis particularly relevant in the PFC environment over a Role 1 with greater medevac capability.3 Early antibiotic therapy and hemodynamic resuscitation with fluids and vasopressors are the key initial therapies for the septic patient. Source control is similarly critical and may require surgery. When this is not possible in the PFC environment, the patient must be supported and transported to a location with surgical capability as rapidly as possible.