View source for Sepsis Septic Shock

==Section 5 - MEDICAL==
===5.17 SEPSIS / SEPTIC SHOCK===


====POSSIBLE SIGNS AND SYMPTOMS:====
*Systemic inflammatory Response Criteria (SIRS):
** Alteration in temperature (Temp. > 100.4° F (38° C) or < 96.8 F [36° C])
** Heart rate > 90 beats per minute
** ETCO2 ≤ 25 mm/Hg
** PaCO2 less than 32 mm/Hg 
** Respiratory Rate greater than 20 breaths per minute
** Systolic blood pressure less than 90 mm/Hg
** New onset confusion or altered level of consciousness
** Blood sugar alteration – greater than 140 mg/dl in non-diabetic patient
** Decreased B/P with warm extremities
** Signs of decreased perfusion (mottling, pallor, capillary refill > 2 seconds)
** Flu-like symptoms (chills, shaking)
** Recent catheterization (eg. NG, Foley, etc.)
** Decreased urine output
** Increased or decreased fluid intake


'''[[Initial Medical Assessment and Care|Initial Medical Care]] (2.01) – Provide OXYGEN or assist ventilations as appropriate for patient condition.'''
* If altered mental status, refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03). 
*Obtain a baseline blood glucose level.
** Administer [[Antidiabetics|D50]] with BGL ≤ 50, consider a half-dose of D50W if BGL < 100mg/dl AND > 50 m/dl. Re-check BGL after administration.
* Obtain an accurate temperature reading.
** IF fever greater than 101° F use passive cooling measures.
** If hypothermic – cover in blankets and take action to conserve heat.
* If patient presents with signs & symptoms of shock, refer to [[Shock|SHOCK PRACTICE PARAMETER (5.13)]]. If sepsis strongly suspected, consider fluid challenge.
** Establish two large bore IVs if possible
*** If hypotensive (< 90 mm/Hg) – Administer FLUID CHALLENGE at 20 ml/Kg
*** If unable to establish IV, consider an INTRAOSSEOUS infusion
* Perform blood draw of all tubes.  The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes.  Document that blood was drawn.
* Complete the Sepsis Screening Form
** Write the patient's temperature on the form
** Two or more positive in major category, 4 or more in minor = possible sepsis
** Four in major category and 4 or more in minor = Issue a sepsis alert
** Two in major category with a ETCO2 ≤ 25 mm/Hg or VENOUS LACTATE of 4 mmol/L or greater = sepsis alert
* Limit scene time to 15 minutes
* If condition worsens despite fluid therapy, administer [[Adrenergics|DOPAMINE]] 5-20 mcg/kg/minute titrated to systolic BP > 90 mm Hg.


'''''Notify hospital of suspected sepsis during radio report.'''''

====Sepsis Screening Form====
[[File:Sepsis Screening FEB 12.pdf]]