Sepsis Septic Shock

Section 5 - MEDICAL

5.17 SEPSIS / SEPTIC SHOCK

POSSIBLE SIGNS AND SYMPTOMS:

• Confusion or altered level of consciousness
• Tachypnea (RR> 20)
• Heart rate > 90
• Decreased B/P with warm extremities
• Alteration in temp (Temp. > 100.4° F or < 96.8)
• Signs of decreased perfusion (mottling, pallor, capillary refill > 2 seconds)
• Flu-like symptoms (chills, shaking)
• Blood sugar alterations
• 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 sensorium, refer to ALTERED MENTAL STATUS PRACTICE PARAMETER (5.03). Administer D50 with BGL ≤ 50, consider a half-dose of D50 if BGL < 100 AND > 50. Re-check BGL.
• 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 patient is hypotensive (< 90 mm Hg.) and unable to establish IV, consider an INTRAOSSEOUS infusion.
• Early identification of sepsis is the key to improved patient outcomes.
• 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

Patients at increased risk
Is the pt very young?	yes	no
Is the pt very old?	yes	no
Has the pt had a general feeling of weakness in the last 3 days?	yes	no
Has the pt had a recent fever (last 3 days)	yes	no
Has the pt recently had a transplant?	yes	no
Is the pt being treated with chemotherapy meds or radiation?	yes	no
Does pt have indwelling urinary cath? (current or recent past)	yes	no
Does pt. have hx of sepsis?	yes	no
Does pt. have any open wounds or decubiti?	yes	no
Does the pt have Diabetes, AIDS, cirrhosis, or other immune system compromise?	yes	no
Does the pt have any large burns or severe injuries?	yes	no
Does the pt have any infections such as Pneumonia, Meningitis, Cellulitis, UTI, etc.?	yes	no
Is the patient on long-term steroid use?	yes	no

Does the patient have any of these signs and symptoms?
Fever > 100 degrees F	yes	no
Hypothermia, a temp < 96.8	yes	no
Hypotension with warm extremities	yes	no
Hyperventilation, >20 breaths/min or PCO2 < 32 mmHG	yes	no
Chills, Shaking	yes	no
Warm skin	yes	no
Rash	yes	no
Increased heart, > 90 BPM	yes	no
Confusion or altered mental status	yes	no
Decreased urine output	yes	no
Hyperglycemia (no hx diabetes) (>200)	yes	no
Other Flu-like symptoms	yes	no
Decreased Perfusion (mottling, pallor, Cap Refill > 2 seconds)	yes	no
Has fluid intake increased or decreased?	yes	no
Dry Mucosa (eyes, corners of mouth, lips)	yes	no
Significant Edema (pretibial, wrist, forehead)	yes	no