Treatment primarily consists of the following: # Giving intravenous fluids # Early antibiotic administration # Early goal directed therapy # Rapid source identification and control # Support of major organ dysfunction Fluids Because lowered blood pressure in<unk>  contributes to poor perfusion, fluid resuscitation is an initial treatment to increase blood volume. Patients demonstrating sepsis-induced hypoperfusion should be initially resuscitated with at least 30 ml/kg of intravenous crystalloid within the first three hours. Crystalloids such as normal saline and lactated Ringer's solution are recommended as the initial fluid of choice, while the use of colloid solutions such as hydroxyethyl starch have not shown any advantage or decrease in mortality. When large quantities of fluids are given, administering albumin has shown some benefit. Antibiotics Treatment guidelines call for the administration of broad-spectrum antibiotics within the first hour following recognition of<unk> . Prompt antimicrobial therapy is important, as risk of dying increases by approximately 10% for every hour of delay in receiving antibiotics. Time constraints do not allow the culture, identification, and testing for antibiotic sensitivity of the specific microorganism responsible for the infection. Therefore, combination antimicrobial therapy, which covers a wide range of potential causative organisms, is tied to better outcomes. Antibiotics should be continued for 7–10 days in most patients, though treatment duration may be shorter or longer depending on clinical response. Vasopressors Among the choices for vasopressors, norepinephrine is superior to dopamine in<unk> . Norepinephrine is the preferred vasopressor, while epinephrine may be added to norepinephrine when needed. Low-dose vasopressin also may be used as an addition to norepinephrine, but is not recommended as a first-line treatment. Dopamine may cause rapid heart rate and arrhythmias, and is only recommended in combination with norepinephrine in those with slow heart rate and low risk of arrhythmia. In the initial treatment of low blood pressure in<unk> , the goal of vasopressor treatment is a mean arterial pressure (MAP) of 65 mm Hg. In 2017, the FDA approved angiotensin II injection for intravenous infusion to increase blood pressure in adults with<unk>  or other distributive shock. Methylene blue Methylene blue has been found to be useful for this condition. Although use of methylene blue has mostly been in adults it has also been shown to work in children. Its mechanism of action is thought to be via the inhibition of the nitric oxide-cyclic guanosine monophosphate pathway. This pathway is excessively activated in<unk> . Methylene blue has been found to work in cases resistant to the usual agents. This effect was first reported in the early 1990s. Other While there is tentative evidence for β-Blocker therapy to help control heart rate, evidence is not significant enough for its routine use. There is tentative evidence that steroids may be useful in improving outcomes. Tentative evidence exists that Polymyxin B-immobilized fiber column hemoperfusion may be beneficial in treatment of<unk> . Trials are ongoing and it is currently being used in Japan and Western Europe. Recombinant activated protein C (drotrecogin alpha) in a 2011 Cochrane review was found not to decrease mortality and to increase bleeding, and thus, was not recommended for use. Drotrecogin alfa (Xigris), was withdrawn from the market in October 2011.
Septic shock
Toxic shock syndrome
Spinal shock
Cryptic shock
Neurogenic shock
Hypovolemic shock
Cardiogenic shock
Obstructive shock