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 Care (2.01) – Provide OXYGEN or assist ventilations as appropriate for patient condition.

• If altered mental status, refer to ALTERED MENTAL STATUS PRACTICE PARAMETER (5.03).
• Obtain a baseline blood glucose level.
  • Administer 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 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 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