Page 144 - PJ MED OPS Handbook 8th Ed
P. 144
Sepsis/Septic Shock
SPECIAL CONSIDERATIONS:
1. Sepsis is a severe, life-threatening, systemic inflammatory response secondary to a seri-
ous bacterial infection.
2. Rapid onset – death may occur within 4–6 hours without antibiotic therapy.
Signs and Symptoms:
1. Hypotension
2. Fever
3. Tachycardia
4. Altered mental status
5. Dyspnea
6. May see skin rash
7. History or source of infection – bug bite, cough, SOB, urinary symptoms, etc.
Management:
1. Reach out to medical control early due to complexity/severity of condition.
2. Obtain IV/IO access.
3. Ertapenem 1g IV/IO daily.
4. If patient is hypotensive, give 30mL/kg normal saline or Ringers lactate fluid bolus. Consider
additional fluids if still hypotensive, then an additional liter titrated to maintain systolic blood
pressure >90mmHg or palpable radial pulse.
5. Consider initiating an epinephrine infusion for persistent hypotension after 3–4L (30mL/kg)
fluid bolus, place epinephrine 1mg (1:1000) into 500mL NS (2mcg/mL) and administer 2–10mL/min
(4–20mcg/min).
6. Place Foley catheter and monitor urine output.
7. Monitor for decreased mental status and be prepared to manage airway. Sedation and positive
pressure ventilation will potentiate hypotension. Ensure continued aggressive fluid resuscitation.
DISPOSITION:
1. Urgent evacuation.
142 n Pararescue Medical Operations Handbook / 8th Edition
