Page 41 - 2023 SMOG Digital

Medical

SEPSIS

History Signs and Symptoms Differential Diagnosis:
• Fever • Altered Mental Status • Cardiogenic shock
• Previous infection • Hyper or hypothermia • Hypovolemic shock
• Recent surgery • Chills • CVA
• Immunocompromised • Myalgia • MI
(transplant, HIV, diabetes, cancer, etc.) • Rigors • Acute renal failure
• Wound • Rash • Hypoglycemia
• Hyperglycemia • Infection not meeting sepsis criteria
• Decreased urine output
Universal Patient Care Guideline
Continued from: O2 (if Hypoxemic)
IV/IO Guideline prn
Tactical Evacuation Guidelines Cardiac Monitor prn 1000mL bolus NS or LR
Check Blood Glucose Followed by assessment for
pulmonary edema and check BP
Return to: Continue fluid resuscitation to
Tactical Evacuation Guideline Known possible source of infection target MAP >65 or 30mL/kg
Or Appropriate Guideline by Complaint (History) STOP for pulmonary edema
Or Differential Diagnosis AND

NO Any of the 2 of the following criteria: YES
• Altered Mental Status (GCS <14)
Consider:
• HR >90 Antibiotic Therapy
• Temp >100.4 o F or <96.8 o F
• SBP <90
• RR >20
• EtCO 2 <25mmHg or PaCO 2 <32
t
YES SBP >90
MAP > 65
IVF 100-200mL/hr NO
Reassess BP q30min YES SBP >90
once MAP >65 for 15min MAP >65
Continue to Monitor Norepinephrine 2-20mcg/min IV
Consider Foley Recheck BP, if MAP <65
NO Add vasopressin 0.03units/min
Recheck BP, if MAP <65
Consider Contact Medical Direction Add epinephrine 2-20mcg/min
Acetaminophen 1g PO, IV, or PR
Consider if available:
0
Ceftriaxone 2g slow IV push or in 100cc NS flow to gravity (immunocompetent)
OR
Cefepime 2g IV in 100cc NS flow to gravity (immunocompromised)
Pearls:
• Early recognition of sepsis allows for attentive care, appropriate fluid resuscitation, vasoactive
medications, and early administration of antibiotics.
• Utilize 6-8mL/kg tidal volumes if artificially ventilated.
• Record urine output if foley in place. Decreased urine output is an indicator of patient deterioration.
• Use vasopressin despite less than maximal norepinephrine. Consider adding it when titrating above

8-10mcg/min IV norepinephrine. Continue it once started and decrease norepinephrine to MAP goal.
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