Difference between revisions of "Sepsis Septic Shock"

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==Section 5 -MEDICAL==
 
==Section 5 -MEDICAL==
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===5.19 CYANIDE TOXICITY / POISONING===
 
  
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Cyanide Poisoning may result from the inhalation, ingestion or dermal exposure to cyanide containing compounds including smoke from closed space fires. Patients who may have had exposure to or inhalation of smoke from products of combustion must be carefully assessed for the possibility of cyanide poisoning in addition to carbon monoxide.
 
  
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Cyanide exposure must be considered when a victim with smoke inhalation has one or more of the following:
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====POSSIBLE SIGNS AND SYMPTOMS:====
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* Common Symptoms:
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*Systemic inflammatory Response Criteria (SIRS):
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** Headache
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** Acute delirium
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** Confusion
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** Alteration in temperature (Temp. > 100.4° F (38° C) or < 96.8 F [36° C])
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** Shortness of Breath
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** Heart rate > 90 beats per minute
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** Chest Pain or tightness
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** ETCO2 ≤ 25 mm/Hg
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** Nausea and/or vomiting
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** PaCO2 less than 32 mm/Hg
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* Common Signs:
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** Respiratory Rate greater than 20 breaths per minute
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** Patient has visible soot around the nose, mouth or oropharynx
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** Systolic blood pressure less than 90 mm/Hg
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** Altered mental status
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** New onset confusion or altered level of consciousness
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** Seizures or coma
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** Blood sugar alteration – greater than 140 mg/dl in non-diabetic patient
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** Dyspnea/Tachypnea
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** Decreased B/P with warm extremities
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** Respiratory distress or apnea
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** Signs of decreased perfusion (mottling, pallor, capillary refill > 2 seconds)
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** Hypertension (early sign)
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** Flu-like symptoms (chills, shaking)
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** Hypotension (late sign)
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** Recent catheterization (eg. NG, Foley, etc.)
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** Cardiovascular collapse or cardiac arrest
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** Decreased urine output
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** Increased or decreased fluid intake
  
  
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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.
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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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* Stabilize the cardiovascular system, ventilations and cardiac compressions as needed.
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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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* If hypotension / shock are present, refer to [[Shock|SHOCK PRACTICE PARAMETER]] (5.13).
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*Obtain a baseline blood glucose level.
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* For patients with a high index of suspicion of cyanide poisoning administer a [[Cyanokit|Cyanokit]] of 5 grams (two 2.5 gram vials) IV/IO over 15 minutes.
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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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** Refer to Handtevy WMD Page for Pediatrics.
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* Obtain an accurate temperature reading.
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** Dilute / prepare the [[Cyanokit|Cyanokit]] product as per manufacturer instructions.
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** IF fever greater than 101° F use passive cooling measures.
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** Use of Cyanocobalamin, hydroxocobalamin or related compound is contraindicated in patients with known anaphylactic reactions to these products.
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** If hypothermic – cover in blankets and take action to conserve heat.
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* If severe symptoms persist after the administration of the first dose of the [[Cyanokit|Cyanokit]] consider administering an additional 5 gram dose of [[Cyanokit|Cyanokit]] over 15 minutes.
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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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* Monitor for signs of hypertension, nausea and / or vomiting.
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** Establish two large bore IVs if possible
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* Transport the patient to the closest facility with hyperbaric capabilities.
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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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'''''Notify hospital of suspected sepsis during radio report.'''''
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====Sepsis Screening Form====
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[[File:Sepsis Screening FEB 12.pdf]]
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[[Category:Medical|0519]]
 
[[Category:Medical|0519]]

Revision as of 10:59, 7 January 2021

Section 5 -MEDICAL

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

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