Sepsis Protocol

Assessment 
Pediatric Pearls: Signs & Symptoms: Differential: 
□ Pediatric hypotension is defined as
SBP < 70 + (age in years x 2) mmHg 
□ Initial NS bolus is 20cc/kg		□ Restlessness
□ confusion
□ weakness 
□ Syncope 
□ Tachycardia 
□ Diaphoresis 
□ Pale, cool, clammy skin 
□ Delayed capillary refill Fever		□ Dehydration 
□ Vomiting 
□ Diarrhea 
□ Congenital heart disease 
□ Medication or Toxin Anaphylaxis 
□ Cardiac Failure (myocarditis) 
□ Pericardial effusion
□ Hemorrhage

Clinical Management Options

EMT-B
• Oxygen, target SpO2 to 92-96% 
• Blood glucose assessment
• Keep the patient warm 
• Provide the hospital a sepsis alert
Paramedic
• Vascular access 
• Monitor ECG and ETCO2
• Fluid bolus
• Pediatric: Isotonic Crystalloid bolus 20 ml/kg may repeat 10 ml/kg bolus x 2 PRN 
• Adult non-cardiac: Isotonic Crystalloid 500-1000 ml bolus, may repeat up to 2 liters 
• Adult Cardiac: Isotonic Crystalloid 250-500 ml bolus, may repeat up to 1 liter Push • Dose Epinephrine for hypotension not improved with fluid bolus
Consult Online Medical Control as Needed

Pearls 

  • Any patient with a sepsis alert should be evaluated by the MD/NP/PA at the stroke stop on arrival to the ED.
  • Adult hypotension can be defined as a systolic blood pressure of < 90 mmHg or MAP < 60 and signs or symptoms of hypoperfusion – altered mental status, increased respirations, tachycardia, poor pulses, skin changes.
  • ETCO2 is often low in shock. ETCO2 <25mmHg is concerning 
  • Consider other possible causes of shock
  • Patients should always have adequate intravascular fluid volume prior to the use of vasopressors-> give fluid if you believe they do not have enough intravascular fluid volume. 
  • MAP calculation = [(2 x diastolic) + systolic] divided by 3 
  • Note that intubating hypotensive patients can cause them to reduce their blood pressure further and cause sudden cardiac arrest. It is appropriate to resuscitate with fluids and optimize oxygen prior to obtaining an advanced airway when possible.