Sepsis

 

History:

 

  • Age > 18 Years
  • Duration of fever
  • Severity of fever
  • Altered mental status
  • Past medical history
  • Medications
  • Immunocompromised
    • Transplant
    • HIV
    • Diabetes
    • Cancer
  • Environmental exposure
  • Last Acetaminophen or Ibuprofen

 

Significant Findings:

 

  • 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

 

Collecting Cultures

 

  • 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
    • Allow to dry
  • Venipuncture and draw blood
    • Add 5-10 mL of blood in each bottle
    • Aerobic (Blue/Gray) first
    • Anaerobic (Purple) second

 

 

 

  • Oxygen
  • Full set of vital signs to include:
  • temperature
  • pulse oximetry
  • respiratory rate

 

 

 

  • 12 Lead EKG
  • Obtain BGL

 

 

 

  • 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)

 

  • Yes
    • Zosyvn 4.5 or 3.375 grams IV;over 10 minutes

 

 

 

  • Notify receiving facility of the Sepsis Alert

 

 

PEARLS:

 

  • 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.

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NREMT

National Registry Emergency Medical Technician