Sepsis Septic Shock: Difference between revisions

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(Created page with "==Section 5 - MEDICAL== ===5.17 SEPSIS / SEPTIC SHOCK=== ====POSSIBLE SIGNS AND SYMPTOMS:==== * Confusion or altered level of consciousness * Tachypnea (RR> 20) * Heart rate...")
 
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====POSSIBLE SIGNS AND SYMPTOMS:====
====POSSIBLE SIGNS AND SYMPTOMS:====
* Confusion or altered level of consciousness
*Systemic inflammatory Response Criteria (SIRS):
* Tachypnea (RR> 20)
** Alteration in temperature (Temp. > 100.4° F (38° C) or < 96.8 F [36° C])
* Heart rate > 90
** Heart rate > 90 beats per minute
* Decreased B/P with warm extremities
** PaCO2 less than 32 mm/Hg
* Alteration in temp (Temp. > 100.4° F or < 96.8)
** Respiratory Rate greater than 20 breaths per minute
* Signs of decreased perfusion (mottling, pallor, capillary refill > 2 seconds)
** Systolic blood pressure less than 90 mm/Hg
* Flu-like symptoms (chills, shaking)
** New onset confusion or altered level of consciousness
* Blood sugar alterations
** Blood sugar alteration – greater than 140 mg/dl in non-diabetic patient
* Recent catheterization (eg. NG, Foley, etc.)
** Decreased B/P with warm extremities
* Decreased urine output
** Signs of decreased perfusion (mottling, pallor, capillary refill > 2 seconds)
* Increased or decreased fluid intake
** Flu-like symptoms (chills, shaking)
** Recent catheterization (eg. NG, Foley, etc.)
** Decreased urine output
** Increased or decreased fluid intake




'''[[Initial Medical Assessment and Care|Initial Medical Care]] (2.01) – Provide OXYGEN or assist ventilations as appropriate for patient condition.'''
'''[[Initial Medical Assessment and Care|Initial Medical Care]] (2.01) – Provide OXYGEN or assist ventilations as appropriate for patient condition.'''
* If altered sensorium, refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03). Administer [[Antidiabetics|D50]] with BGL ≤ 50, consider a half-dose of D50 if BGL < 100 AND > 50. Re-check BGL.
* If altered sensorium, refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03).  
* If patient presents with signs & symptoms of shock, refer to [[Shock|SHOCK PRACTICE PARAMETER]] (5.13). If sepsis strongly suspected, consider fluid challenge.
*Obtain a baseline blood glucose level.
* Establish two large bore IVs if possible. If patient is hypotensive (< 90 mm Hg.) and unable to establish IV, consider an INTRAOSSEOUS infusion.
** Administer [[Antidiabetics|D50]] with BGL ≤ 50, consider a half-dose of D50W if BGL < 100mg/dl AND > 50 m/dl. Re-check BGL after administration.
* Early identification of sepsis is the key to improved patient outcomes.
* Obtain an accurate temperature reading.
** IF fever greater than 101° F use passive cooling measures.
** If hypothermic – cover in blankets and take action to conserve heat.
* Obtain a [[Venous Lactate Monitoring Procedure|VENOUS LACTATE]] level reading (Greater than 4 mmol/L is positive)
* If patient presents with signs & symptoms of shock, refer to [[Shock|SHOCK PRACTICE PARAMETER (5.13)]]. If sepsis strongly suspected, consider fluid challenge.
** Establish two large bore IVs if possible
*** If hypotensive (< 90 mm/Hg) – Administer FLUID CHALLENGE at 20 ml/Kg
*** If unable to establish IV, consider an INTRAOSSEOUS infusion
* Complete the Sepsis Screening Form
** Two or more positive in major category, 4 or more in minor = possible sepsis
** Four in major category and 4 or more in minor = Issue a sepsis alert
** Two in major category with a VENOUS LACTATE of 4 mmol/L or greater = sepsis alert
* Limit scene time to 15 minutes
* Limit scene time to 15 minutes
* If condition worsens despite fluid therapy, administer DOPAMINE 5 - 20 mcg/kg/minute titrated to systolic BP > 90 mm Hg.
* If condition worsens despite fluid therapy, administer [[Adrenergics|DOPAMINE]] 5-20 mcg/kg/minute titrated to systolic BP > 90 mm Hg.




'''''Notify hospital of suspected sepsis during radio report.'''''
'''''Notify hospital of suspected sepsis during radio report.'''''
'''Sepsis Screening'''
{| class="wikitable"
|-
! '''Patients at increased risk''' 
|-
| Is the pt very young?|| yes|| no
|-
| Is the pt very old?|| yes|| no
|-
| Has the pt had a general feeling of weakness in the last 3 days?|| yes|| no
|-
| Has the pt had a recent fever (last 3 days)|| yes|| no
|-
| Has the pt recently had a transplant?|| yes|| no
|-
| Is the pt being treated with chemotherapy meds or radiation?|| yes|| no
|-
| Does pt have indwelling urinary cath? (current or recent past)|| yes|| no
|-
| Does pt. have hx of sepsis?|| yes|| no
|-
| Does pt. have any open wounds or decubiti?|| yes|| no
|-
| Does the pt have Diabetes, AIDS, cirrhosis, or other immune system compromise?|| yes|| no
|-
| Does the pt have any large burns or severe injuries?|| yes|| no
|-
| Does the pt have any infections such as Pneumonia, Meningitis, Cellulitis, UTI, etc.?|| yes|| no
|-
| Is the patient on long-term steroid use?|| yes|| no
|}
{| class="wikitable"
|-
! '''Does the patient have any of these signs and symptoms?'''
|-
| Fever > 100 degrees F|| yes|| no
|-
| Hypothermia, a temp < 96.8|| yes|| no
|-
| Hypotension with warm extremities|| yes|| no
|-
| Hyperventilation, >20 breaths/min or PCO2 < 32 mmHG|| yes|| no
|-
| Chills, Shaking|| yes|| no
|-
| Warm skin|| yes|| no
|-
| Rash || yes|| no
|-
| Increased heart, > 90 BPM|| yes|| no
|-
| Confusion or altered mental status|| yes|| no
|-
| Decreased urine output|| yes|| no
|-
| Hyperglycemia (no hx diabetes) (>200)|| yes|| no
|-
| Other Flu-like symptoms|| yes|| no
|-
| Decreased Perfusion (mottling, pallor, Cap Refill > 2 seconds)|| yes|| no
|-
| Has fluid intake increased or decreased?|| yes|| no
|-
| Dry Mucosa (eyes, corners of mouth, lips)|| yes|| no
|-
| Significant Edema (pretibial, wrist, forehead)|| yes|| no
|}

Revision as of 13:58, 10 May 2012

Section 5 - MEDICAL

5.17 SEPSIS / SEPTIC SHOCK

POSSIBLE SIGNS AND SYMPTOMS:

  • Systemic inflammatory Response Criteria (SIRS):
    • Alteration in temperature (Temp. > 100.4° F (38° C) or < 96.8 F [36° C])
    • Heart rate > 90 beats per minute
    • PaCO2 less than 32 mm/Hg
    • Respiratory Rate greater than 20 breaths per minute
    • Systolic blood pressure less than 90 mm/Hg
    • New onset confusion or altered level of consciousness
    • Blood sugar alteration – greater than 140 mg/dl in non-diabetic patient
    • Decreased B/P with warm extremities
    • Signs of decreased perfusion (mottling, pallor, capillary refill > 2 seconds)
    • Flu-like symptoms (chills, shaking)
    • Recent catheterization (eg. NG, Foley, etc.)
    • Decreased urine output
    • Increased or decreased fluid intake


Initial Medical Care (2.01) – Provide OXYGEN or assist ventilations as appropriate for patient condition.

  • If altered sensorium, refer to ALTERED MENTAL STATUS PRACTICE PARAMETER (5.03).
  • Obtain a baseline blood glucose level.
    • Administer D50 with BGL ≤ 50, consider a half-dose of D50W if BGL < 100mg/dl AND > 50 m/dl. Re-check BGL after administration.
  • Obtain an accurate temperature reading.
    • IF fever greater than 101° F use passive cooling measures.
    • If hypothermic – cover in blankets and take action to conserve heat.
  • Obtain a VENOUS LACTATE level reading (Greater than 4 mmol/L is positive)
  • If patient presents with signs & symptoms of shock, refer to SHOCK PRACTICE PARAMETER (5.13). If sepsis strongly suspected, consider fluid challenge.
    • Establish two large bore IVs if possible
      • If hypotensive (< 90 mm/Hg) – Administer FLUID CHALLENGE at 20 ml/Kg
      • If unable to establish IV, consider an INTRAOSSEOUS infusion
  • Complete the Sepsis Screening Form
    • Two or more positive in major category, 4 or more in minor = possible sepsis
    • Four in major category and 4 or more in minor = Issue a sepsis alert
    • Two in major category with a VENOUS LACTATE of 4 mmol/L or greater = sepsis alert
  • Limit scene time to 15 minutes
  • If condition worsens despite fluid therapy, administer DOPAMINE 5-20 mcg/kg/minute titrated to systolic BP > 90 mm Hg.


Notify hospital of suspected sepsis during radio report.

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