Difference between revisions of "Sepsis Septic Shock"

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==Section 5 - MEDICAL==
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==Section 5 -MEDICAL==
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===5.17 SEPSIS / SEPTIC SHOCK===
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===5.18 SUSPECTED KIDNEY STONE===
  
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[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - Provide [[Oxygen|OXYGEN]] or assist ventilations as appropriate for patient condition. Use vomiting precautions.
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* If age >50, consider Abdominal Aortic Aneurysm etiology
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* If hypotension / shock are present, refer to [[Shock|SHOCK PRACTICE PARAMETER]] (5.13).
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* For patients with severe vomiting, obtain detailed history, and then administer [[Zofran|ZOFRAN (ONDANSETRON HYDROCHLORIDE)]]:
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** Adult: 4mg slow IVP. (Consider diluting in 10-20cc to aid in administering slowly) or 4mg/2ml deep IM in a large muscle.
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** Pediatric : Refer to Handtevy System
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*Obtain detailed history as to hydration status:
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** Dry mucous membranes, tongue
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** Sunken eyes
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** Urine output
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** Multiple episodes of vomiting or diarrhea
  
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====POSSIBLE SIGNS AND SYMPTOMS:====
 
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*Systemic inflammatory Response Criteria (SIRS):
 
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** Acute delirium
 
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** Alteration in temperature (Temp. > 100.4° F (38° C) or < 96.8 F [36° C])
 
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** Heart rate > 90 beats per minute
 
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** ETCO2 ≤ 25 mm/Hg
 
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** PaCO2 less than 32 mm/Hg
 
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** Respiratory Rate greater than 20 breaths per minute
 
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** Systolic blood pressure less than 90 mm/Hg
 
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** New onset confusion or altered level of consciousness
 
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** Blood sugar alteration – greater than 140 mg/dl in non-diabetic patient
 
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** Decreased B/P with warm extremities
 
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** Signs of decreased perfusion (mottling, pallor, capillary refill > 2 seconds)
 
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** Flu-like symptoms (chills, shaking)
 
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** Recent catheterization (eg. NG, Foley, etc.)
 
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** Decreased urine output
 
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** Increased or decreased fluid intake
 
  
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'''''If PROPERLY hydrated and no suspected dehydration, consider administration of: [[Toradol|TORADOL (KETOLORAC)]] 30mg slow IVP'''''
  
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'''[[Initial Medical Assessment and Care|Initial Medical Care]] (2.01) – Provide OXYGEN or assist ventilations as appropriate for patient condition.'''
 
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* If altered mental status, refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03).
 
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*Obtain a baseline blood glucose level.
 
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** 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.
 
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* Obtain an accurate temperature reading.
 
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** IF fever greater than 101° F use passive cooling measures.
 
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** If hypothermic – cover in blankets and take action to conserve heat.
 
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* If patient presents with signs & symptoms of shock, refer to [[Shock|SHOCK PRACTICE PARAMETER (5.13)]]. If sepsis strongly suspected, consider fluid challenge.
 
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** Establish two large bore IVs if possible
 
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*** If hypotensive (< 90 mm/Hg) – Administer FLUID CHALLENGE at 20 ml/Kg
 
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*** If unable to establish IV, consider an INTRAOSSEOUS infusion
 
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* 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.
 
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* Complete the Sepsis Screening Form
 
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** Write the patient's temperature on the form
 
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** Two or more positive in any category = consider sepsis alert.
 
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** Two in major category with a ETCO2 ≤ 25 mm/Hg = sepsis alert
 
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* Limit scene time to 15 minutes
 
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* If condition worsens despite fluid therapy, administer [[Dopamine|DOPAMINE]] 5-20 mcg/kg/minute titrated to systolic BP > 90 mm Hg.
 
  
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'''''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'''''
  
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'''''Notify hospital of suspected sepsis during radio report.'''''
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If patient presents with:
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* Possible dehydration
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* History of renal impairment
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* Current renal impairment
  
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====Sepsis Screening Form====
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Fluid Bolus, 200-300cc NS followed by [[Toradol|TORADOL (KETOROLAC)]] 15mg slow IVP. Administer nothing by mouth.
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[[File:Sepsis Screening FEB 12.pdf]]
 
  
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[[Category:Medical|0518]]
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[[Category:Medical|0517]]
 

Revision as of 06:13, 13 November 2020

Section 5 -MEDICAL

5.18 SUSPECTED KIDNEY STONE

INITIAL MEDICAL CARE (2.01) - Provide 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 PRACTICE PARAMETER (5.13).
  • For patients with severe vomiting, obtain detailed history, and then administer 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


If PROPERLY hydrated and no suspected dehydration, consider administration of: TORADOL (KETOLORAC) 30mg slow IVP


For Pain Management: Refer to ANALGESIA/SEDATION PRACTICE PARAMETERS (2.04) MORPHINE 2-20 mg (IV,IO, IN, IM), titrated to effect

If patient presents with:

  • Possible dehydration
  • History of renal impairment
  • Current renal impairment

Fluid Bolus, 200-300cc NS followed by TORADOL (KETOROLAC) 15mg slow IVP. Administer nothing by mouth.

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