SEPSIS

Diagnosing Severe Sepsis
  • A known or suspected infection +
  • 2 or more SIRS Criteria +
    • Temperature greater than 101F or less than 96.8F
    • Heart rate greater than 90
    • Respirations greater than 20 per minute
    • White blood cell count greater than 12,000 or less than 4,000 or 10% bands.
  • 1 or more Signs of Organ Failure
    • SBP <90, MAP <65, or SBP decrease of more than 40 mmHg from previous normal BP.
    • Creatinine > 2.0 or urine output <0.5 ml/kg/hr for 2 hours
    • Bilirubin > 2mg/dL
    • Platelet Count <100,000
    • INR > 1.5 or aPTT >60
    • Lactate > 2mmol/L
    • Change in mental status
    • SaO2 SAT less than 90% or increasing O2 requirements
Complete within 3 HOURS
  • Measure lactate level
  • Obtain blood cultures prior to administration of antibiotics
  • Administer broad spectrum antibiotics
  • Administer 30ml/kg crystalloid bolus for hypotension
Complete within 6 HOURS
  • Apply vasopressors (for hypotension that does not respond to fluid resuscitation) maintain a map >65
  • In the event of persistent hypotension after initial fluid aminstration or if initial lactate was >4 re-assess volume status and tissue perfusion
  • Re-measure lactate if initial lactate was elevated >2
Documenting Reassessment

Repeat focused exam after initial fluid resuscitation by licensed independed practitioner including vital signs, cardiopulmonary, capillary refill, peripheral  pulse and skin findings.