Sepsis continues to be a high-mortality illness. Optimal treatment requires attention to detail and the implementation of many time-dependent therapies starting at the recognition of occult sepsis. We should strive for early empiric antibiotic administration. Early goal-directed resuscitation, as proposed by Rivers et al,5has been shown to reduce mortality in this patient population. The treatment of sepsis-induced adrenal insufficiency and tight glycemic control play a significant role in reducing mortality. High-risk patients benefit from the administration of activated protein C. The treatment of sepsis at this time is akin to our current understanding of acute myocardial infarction. There is no magic bullet; rather, several therapies must be quickly brought to bear on this complex pathologic state to maximize the benefit of each intervention while limiting the incurred risk. In our minds, the same holds true for the intubation of a septic patient. This is a high-stakes intervention with a large potential cost if it is not performed well. Significant aspiration or a prolonged period of hypotension may well abolish any benefit from all of the above therapies. We think that etomidate is still a very good agent for the induction of unconsciousness, and when combined with muscle relaxation provides the best scenario for rapid, smooth, hemodynamically stable intubation. The basics of care, the “ABCs,” should not be forgotten. Immediate correction of respiratory failure should be performed in a manner that impacts the circulatory system the least. In a Dutch study, Arbous et al6demonstrated that about two thirds of the mortality during the induction phase of anesthesia was due to cardiovascular events. This underscores the need for hemodynamic stability during anesthesia induction. Etomidate provides the stability and predictability needed to be a first-line agent. From a practical standpoint, a better anesthetic induction agent is simply not available. As Jackson states it, it is sometimes necessary to stabilize the immediate situation while accepting a future cost. In this case, the future cost is adrenal suppression. Fortunately, the limited available data indicate that this effect is completely reversed with the administration of corticosteroids. For this reason, we think that all hypotensive septic patients should be treated with stress doses of corticosteroids, particularly if the random (stress) cortisol level is < 25 μg/dL.7 We recommend initiating therapy with hydrocortisone, 100 mg IV every 8 h, until the results of the stress cortisol level measurements are available. The “cost” of such an approach is likely to be very low, and the potential benefit to be quite high. The cost of such an approach is likely to be very low, and the potential benefit to be quite high.