Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

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

 

Treatment:

 

  • 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

 

Documented or reported Penicillin Allergy?

 

  • Yes

 

    • Contact Medical Control

 

  • No

 

    • Nursing Home Patient?

 

  • Yes

 

    • Zosyvn 4.5 or 3.375 grams IV;over 10 minutes

 

Nursing Home Patient?

 

  • No

 

Suspected pneumonia?

 

  • Yes

 

    • Rocephin 2 grams IV; over 10 minutes

 

 

  • Notify receiving facility of the Sepsis Alert

 

 

PEARLS:

 

  • IF unable to obtain cultures, do not administer antibiotics
  • Determine the hospital destination prior to drawing cultures. Use the appropriate kit.
  • Utilize Sepsis Checklist and document "Blood Cultures Drawn" in flowchart of PCR
  • 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 q3-5 minutes or Leophed 2-30 mcg/min IV/IO titrate to maintain a MAP > 65
  • 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.