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. 2026 Sep 22;13:1919161. doi: 10.3389/fmed.2026.1919161

Figure 1.

Diagram showing standard sepsis care alongside two linked ultrasound pathways. A blue box on the left lists antimicrobials, cultures and vascular access, perfusion assessment, and source-control planning. Green boxes in the center show source-oriented assessment of the lung, pleura, biliary system, kidneys, bladder, and soft tissues, and physiologic reassessment using focused cardiac ultrasound, passive leg raising with Doppler flow assessment, serial lung ultrasound, and optional venous assessment. Orange boxes on the right describe diagnostic escalation and repeated fluid or vasopressor decisions. Connecting arrows and a returning arrow illustrate linked decisions and serial reassessment, with ultrasound complementing standard care.

Two-arm ED POCUS framework for source-oriented assessment and physiologic reassessment in sepsis and septic shock. POCUS runs in parallel with standard sepsis care and supports selected escalation and reassessment decisions without replacing antimicrobials, source control, comprehensive imaging, or clinical judgment. CT, computed tomography; ED, emergency department; FoCUS, focused cardiac ultrasound; LUS, lung ultrasound; LVOT, left ventricular outflow tract; PLR, passive leg raise; POCUS, point-of-care ultrasound; VTI, velocity-time integral.