Sepsis is the most common cause of death in children. Its adequate management has a significant impact on morbidity and mortality. Pediatricians who take initial contact with these patients play a fundamental role in the chain of actions that start at the Emergency Area and finish in the Intensive Care Unit. In recent years, some strategies have been developed to achieve staggered targets: clinical, hemodynamic, biochemical, and oxygenation. The correct interpretation of each affected component will allow the most appropriate intervention. The aggressive management with fluids and the early indication of inotropes are the basis for the management of shock. This paper summarizes primary interventions in the Emergency Department.