) Early goal-directed therapy should be employed for patients with septic shock or severe sepsis. The tenets of resuscitation include intubation if hypoxic, fluid resuscitation to a central venous pressure target of 8 to 12 mm Hg if not intubated and infusion of vasopressors to maintain a mean aerial pressure of 65 mm Hg. Norepinephrine and dopamine are the vasopressors of choice; epinephrine vasoconstricts peripherally as well as increases cardiac contractility and is not a first-line agent for septic shock. Inotropes such as dobutamine have been used if oxygen delivery is low, but should not be used to push delivery to supranormal levels. Fuhermore, cultures should be drawn immediately and empiric antibiotics initiated; if there is a surgical source of sepsis, then operative intervention for source control should be promptly performed after initial resuscitative effos. Recombinant-activated protein C is indicated in patients with severe sepsis with a predicted high risk of moality (ie, older age, increased severity of disease); this patient does not have evidence of end-organ dysfunction such as acute renal or respiratory failure at this time. The use of coicosteroids for septic shock is controversial, but should only be considered in the setting of shock nonresponsive to fluids and vasopressors. Miller&;s anaesthesia 9th edition page no 786