Sepsis Septic Shock
Section 5 - MEDICAL
5.17 SEPSIS / SEPTIC SHOCK
POSSIBLE SIGNS AND SYMPTOMS:
- Systemic inflammatory Response Criteria (SIRS):
- Acute delirium
- 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
- Establish two large bore IVs if possible
- Perform blood draw of all tubes. The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes. Document that blood was drawn.
- Complete the Sepsis Screening Form
- Write the patient's temperature on the form
- Two or more positive in any category = consider 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.