- Age > 18 Years
- Duration of fever
- Severity of fever
- Altered mental status
- Past medical history
- Environmental exposure
- Last Acetaminophen or Ibuprofen
- Hyperthermia (>101⁰F/38⁰C)
- Hypothermia (<96.8⁰F/36⁰C)
- Heart rate > 90 beats per minute
- Respiratory rate >20 breaths per minute or mechanical ventilation
- Pneumonia (cough/thick sputum)
- Urinary tract infection
- Acute mental status change
- Abdominal infection
- Wound infection
- Skin/soft tissue infection
- Suspected meningitis, endocarditis
- Maintain aseptic technique at all times
- Put on a new set of clean gloves
Prepare site with Chloraprep
- Clean 2 inch site
- Allow site to dry
- Do not touch once cleaned
- Remove cap from cultural bottles
Clean bottle diaphragm with alcohol
Venipuncture and draw blood
- Add 5-10 mL of blood in each bottle
- Aerobic (Blue/Gray) first
- Anaerobic (Purple) second
Full set of vital signs to include:
- pulse oximetry
- respiratory rate
- Draw 1 set of blood cultures
- Draw Lactate per receiving destination
- Initiate IV administration 1,000 mL
- Establish 2nd IV when feasible
- If PCN allergy DO NOT administer antibiotics.
- Presumed sepsis from pneumonia (all patients coming from any location other than a nursing home)
- Rocephin 1 gram IV; over 10 minutes
- Nursing Home Patient? (or acquired pneumonia from recent long term stay at nursing home or admitted to the hospital)
- Zosyvn 4.5 or 3.375 grams IV;over 10 minutes
- Notify receiving facility of the Sepsis Alert
- IF unable to obtain cultures, do not administer antibiotics
- If a patient is allergic to Chloraprep, scrub the venipuncture site with alcohol for 30 seconds and then tincture of iodine or betadine in concentric circles away from the site covering a 1-2 inch area and allow to dry
- Inspect the blood culture bottles. Bottles must have no cracks, not be expired. Remove the protective flip top overcap and decontaminate bottle diaphragm top with 70% alcohol (bottle tops are not sterile). Allow the alcohol on the diaphragm to completely dry before adding patient’s blood to the bottle.
- Determine the hospital destination (SFHS or GHS) prior to drawing cultures. Use the appropriate kit.
- Utilize Sepsis Check List
- Be alert for signs of anaphylaxis during antibiotic administration.
- Septic shock ‐ Hypotension (SBP <90) refractory to fluid bolus (30ml/kg NS), Consider Push Dose Epi 10-20 mcg q10-15 minutes.
- A second liter of Normal Saline can be administered for septic shock.
- Extended scene times to provide antibiotic therapy are acceptable
- Withhold antibiotics if suspected meningitis, endocarditis or osteomyelitis.
- Zosyn should be administered to all nursing home patients who meet sepsis alert criteria without a PCN allergy regardless of the source.