Page 277 - ATP-P 11th Ed

SEPSIS / SEPTIC SHOCK PROTOCOL

SPECIAL CONSIDERATIONS
1. Sepsis is a severe, life-threatening bacterial blood infection.
2. Rapid onset – death may occur within 4–6 hours without antibiotic therapy.

Signs and Symptoms
1. Hypotension
2. Fever SECTION 2
3. Tachycardia
4. Altered mental status
5. Dyspnea
6. May see skin rash (purpura or petechiae)
Management
1. Obtain IV/IO access.
2. Ertapenem (Invanz ) 1g IV/IO daily OR ceftriaxone (Rocephin ) 2g IV/IO
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3. If patient is hypotensive, give 1L normal saline or Ringer’s lactate fluid bolus. Consider
additional fluids if still hypotensive, then an additional liter titrated to maintain systolic
blood pressure >90mmHg or palpable radial pulse.
a. Hextend 500mL IV boluses may be used (if crystalloids are unavailable) to main-
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tain palpable radial pulse of systolic BP of 90mmHg.
4. Push dose IV epinephrine for persistent hypotension after fluid bolus.
a. DO NOT GIVE UNDILUTED (1:1,000) EPINEPHRINE
INTRAVENOUSLY.
b. Take a 10mL syringe and draw up 1mL of 1:1,000 epinephrine.
c. Then draw up 9mL of normal saline into this syringe.
d. Waste 9mL of this mixture, then draw up 9mL more of normal saline into the same
syringe.
e. Final concentration is 10mL of 1:100,000 epinephrine, 10mcg/mL.
f. Administer 0.5–2mL (5–20mcg) IV/IO to maintain radial pulse or SBP >90mmHg.
5. Dexamethasone (Decadron ) 10mg IV if persistent hypotension after fluid bolus
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and epinephrine
6. Monitor for decreased mental status and be prepared to manage airway.

Disposition
Urgent evacuation

266 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 267