Page 66 - ATP-P 11th Ed

Sepsis Treatment

SECTION 1 Table 14 Sepsis Treatments/Interventions Paradigm
Intervention
Antimicrobial • Minimum: Moxifloxacin 400mg PO daily
• Better: Ertapenem 1g IV/IO q24hr OR ceftriaxone 2g IV/IO q24hr
Therapy
• Best: ceftriaxone 2gIV/IO q24hr, PLUS vancomycin 1.5mg/kg IV/IO q12hr,
PLUS metronidazole 500mg IV/PO/IO q8hr
Antiparasitic • Minimum: Atovaquone/progauanil (Malarone) 4x3 regimen – 4 tablets PO daily
Regimens for 3 days
• Better/Best: Artemether/lumefantrine (Coartem) 4 tablets PO initially, then
4 tablets after 8 hours, then 4 tablets PO twice daily for 2 more days (24 tablets
total)
Antifungal
Regimens • Minimum/Better/Best: Fluconazole 400mg PO/IV daily
Fluid • Minimum: In the absence of IV/IO capability, have the patient drink water
Resuscitation » If available, include electrolyte oral rehydration solution, especially for patients
who cannot consume food
• Better: IV/IO crystalloids:
» Initial rapid infusion of 30mL/kg should be given upon identification of sepsis
» LR or NS to maintain SBP >90mmHg or MAP ≥ 65mmHg
» If plasma is being given that volume can count toward the 30mL/kg goal
• Best: The same fluid resuscitation strategy as above with the addition of a uri-
nary catheter for more precise measuring of UOP
Vasopressors • After fluid resuscitation, if there is no observed positive change in SBP, MAP,
UOP and/or mental status, vasopressor medications should be given
• All use of pressers should be administered by role-based approved protocols or
teleconsultation approval
• First-line – norepinephrine infusion
• Second-line – epinephrine infusion
• Refer to Drip table below for preparation, starting dose, and drip rates
Additional • Consider hydrocortisone or dexamethasone administration for possible adrenal
Medications insufficiency if there is a poor response to vasopressor initiation/titration
» Administer antipyretics (acetaminophen, if available. Non-steroidal anti-
inflammatory drugs [NSAIDs] should be avoided as they may impair renal
function)

56 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 57