Sepsis Septic Shock: Difference between revisions

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** Alteration in temperature (Temp. > 100.4° F (38° C) or < 96.8 F [36° C])
** Alteration in temperature (Temp. > 100.4° F (38° C) or < 96.8 F [36° C])
** Heart rate > 90 beats per minute
** Heart rate > 90 beats per minute
** PaCO2 less than 32 mm/Hg
** ETCO2 ≤ 25 mm/Hg
** PaCO2 less than 32 mm/Hg  
** Respiratory Rate greater than 20 breaths per minute
** Respiratory Rate greater than 20 breaths per minute
** Systolic blood pressure less than 90 mm/Hg
** Systolic blood pressure less than 90 mm/Hg
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'''[[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).  
* If altered mental status, refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03).  
*Obtain a baseline blood glucose level.
*Obtain a baseline blood glucose level.
** 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.
** 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.
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** IF fever greater than 101° F use passive cooling measures.
** IF fever greater than 101° F use passive cooling measures.
** If hypothermic – cover in blankets and take action to conserve heat.
** 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.
* 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
** Establish two large bore IVs if possible
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** Two or more positive in major category, 4 or more in minor = possible sepsis
** 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
** 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
** Two in major category with a ETCO2 ≤ 25 mm/Hg or 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 [[Adrenergics|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.

Revision as of 15:07, 8 July 2016

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
    • ETCO2 ≤ 25 mm/Hg
    • 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 mental status, 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.
  • 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
    • Write the patient's temperature on the 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 ETCO2 ≤ 25 mm/Hg or 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.

Sepsis Screening Form

File:Sepsis Screening FEB 12.pdf

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