A 46-year-old family physician working in a remote northern nursing station is managing a 63-year-old man with sepsis from pneumonia. After fluid resuscitation and broad-spectrum antibiotics, the patient remains hypotensive (BP 82/48 mmHg) with lactate 4 mmol/L. There is no on-site ICU. According to Surviving Sepsis principles adapted in Canadian practice, what is the best next step?