Page 51 - 2026 SMOG

SEPSIS/FEVER
History Definition
• Wound(s) with signs of infection • Life-threatening organ dysfunction caused
• Warm, flushed >100.4°F/38°C by a dysregulated host response to infection
• Diaphoretic, chills <96.8°F/36°C • Septic shock is a form of distributive shock
• Capillary refill time >3 seconds • Keys to Success
• Abnormal vital signs ˚ Early recognition
˚ HR >90 ˚ Identification of the cause of shock
˚ SBP <90 ˚ Early, decisive treatment of the cause and
RR >20/min
initiation of cause-specific resuscitation.
˚
• Altered mental status
• Decreased urine output
• Rash(es), purpura
• Immunosuppressed
Treatment
• Initiate Monitoring: ECG, NIBP, SpO , EtCO , Temp
2
2
• Supplemental O , goal >93% room air
2
• Check glucose (<70mg/dL HYPOGLYCEMIA PROTOCOL)
• Attain a minimum of 2 IV/IO sites
• Initiate IV/IO crystalloid therapy—1000mL bolus NS/LR achieve goal of SBP >90 or MAP
>65 or 30mL/kg
• Initiate/monitor Foley. UOP 0.3–0.5mL/kg/hr
• Temperature >100.4°F/38°C, consider Acetaminophen 1g PO/IV (if not provided in the
last 6hr.)
• Persistent or refractory hypotension after 2L NS/LR, unable to maintain SBP >90 or MAP >65
˚ Administer Norepinephrine 5–15mcg/min IV SBP <90 or MAP <65
• Add Epinephrine (0.1mg/mL) 2–10mcg/min
• Consider antibiotic therapy: Ceftriaxone 2g in 250mL NS over 5min or Ertapenem 1g
IV/IO daily.
• Contact Medical Control for further guidance if able.
Notes, Cautions, Warnings
• Monitor overall respiratory status. Many patients who are critically ill with sepsis will need
ventilatory support at some point in their management.
• Record urine output if a Foley is in place. Decreased urine output is an indicator of patient
deterioration.
• Fever may not be present in immunocompromised individuals, the elderly, or those on
immunosuppressive drugs.
• Not all fever is due to infection—evaluate for environmental/thyroid/toxic etiology.
• Blood is preferred in trauma sepsis.
• Caution in overresuscitation >0.5mL/kg/hr UOP, wet lungs, increased work of breathing
Reference: CPG ID #83 (Sepsis Management in PFC)

2026 Standard Medical Operating Guidelines (SMOG) • 43