Difference between revisions of "Sepsis Septic Shock"

From Practice Parameters
Jump to navigation Jump to search
 
(2 intermediate revisions by the same user not shown)
Line 1: Line 1:
 
==Section 5 -MEDICAL==
 
==Section 5 -MEDICAL==
−
===5.18 SUSPECTED KIDNEY STONE===
+
===5.17 SEPSIS / SEPTIC SHOCK===
  
−
[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - Provide [[Oxygen|OXYGEN]] or assist ventilations as appropriate for patient condition. Use vomiting precautions.
 
−
* If age >50, consider Abdominal Aortic Aneurysm etiology
 
−
* If hypotension / shock are present, refer to [[Shock|SHOCK PRACTICE PARAMETER]] (5.13).
 
−
* For patients with severe vomiting, obtain detailed history, and then administer [[Zofran|ZOFRAN (ONDANSETRON HYDROCHLORIDE)]]:
 
−
** Adult: 4mg slow IVP. (Consider diluting in 10-20cc to aid in administering slowly) or 4mg/2ml deep IM in a large muscle.
 
−
** Pediatric : Refer to Handtevy System
 
−
*Obtain detailed history as to hydration status:
 
−
** Dry mucous membranes, tongue
 
−
** Sunken eyes
 
−
** Urine output
 
−
** Multiple episodes of vomiting or diarrhea
 
  
 +
====POSSIBLE SIGNS AND SYMPTOMS:====
 +
*Systemic inflammatory Response Criteria (SIRS):
 +
** Acute delirium
 +
** 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
  
−
'''''If PROPERLY hydrated and no suspected dehydration, consider administration of: [[Toradol|TORADOL (KETOLORAC)]] 30mg slow IVP'''''
 
  
 +
'''[[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 [[Dextrose_50%25|DEXTROSE 50%]] or [[Dextrose_10%25|DEXTROSE 10%]] with BGL ≤ 50, consider a half-dose of 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 any category = consider sepsis alert.
 +
** Two in major category with a ETCO2 ≤ 25 mm/Hg = sepsis alert
 +
* Limit scene time to 15 minutes
 +
* If condition worsens despite fluid therapy, administer [[Dopamine|DOPAMINE]] 5-20 mcg/kg/minute titrated to systolic BP > 90 mm Hg.
  
−
'''''For Pain Management: Refer to [[Analgesia and Sedation|ANALGESIA/SEDATION PRACTICE PARAMETERS]] (2.04) [[Morphine_Sulfate|MORPHINE]] 2-20 mg (IV,IO, IN, IM), titrated to effect'''''
 
  
−
If patient presents with:
+
'''''Notify hospital of suspected sepsis during radio report.'''''
−
* Possible dehydration
 
−
* History of renal impairment
 
−
* Current renal impairment
 
  
−
Fluid Bolus, 200-300cc NS followed by [[Toradol|TORADOL (KETOROLAC)]] 15mg slow IVP. Administer nothing by mouth.
+
====Sepsis Screening Form====
 +
[[File:Sepsis Screening FEB 12.pdf]]
  
−
[[Category:Medical|0518]]
+
 
 +
[[Category:Medical|0519]]

Latest revision as of 11:26, 7 January 2021

Section 5 -MEDICAL

5.17 SEPSIS / SEPTIC SHOCK

POSSIBLE SIGNS AND SYMPTOMS:

  • Systemic inflammatory Response Criteria (SIRS):
    • Acute delirium
    • 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 DEXTROSE 50% or DEXTROSE 10% with BGL ≤ 50, consider a half-dose of 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 any category = consider sepsis alert.
    • Two in major category with a ETCO2 ≤ 25 mm/Hg = 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

Sepsis Screening FEB 12.pdf

Retrieved from "http://mfrdinfo.com/ems1/index.php?title=Sepsis_Septic_Shock&oldid=27779"