General Approach to All Patients

Sepsis

Sepsis is a rapidly progressing, life threatening condition due to systemic infection. Sepsis must be recognized early and treated aggressively to prevent progression to shock and death. Sepsis can be identified when the following markers of the Systemic Inflammatory Response Syndrome (SIRS) are present in a patient with suspected infection:

  • Temperature > 38° C (100.4° F) OR < 36° C (96.8° F)
  • Respiratory Rate > 20 breaths/min
  • Heart Rate > 90 beats/min

In addition to physiologic markers of SIRS, severe sepsis may cause hypoxia and inadequate organ perfusion, resulting in metabolic acidosis marked by elevated blood lactate levels and decreased ETCO2 levels (measured by capnography)

Sepsis Alert

The purpose of a Sepsis Alert is to provide pre-arrival Emergency Department notification in order to facilitate rapid assessment and treatment of a suspected severe sepsis patient. Sepsis Alert patients should be transported to a hospital with on-site intensive care services (NOT a free standing Emergency Department).

A Sepsis Alert will be instituted for patients meeting the following 3 criteria:

  1. Suspected infection
  2. Two or more of the following:
    • Temperature > 38° C (100.4° F) OR < 36° C (96.8° F)
    • Respiratory Rate > 20 breaths/min
    • Heart Rate > 90 beats/min
  3. ETCO2 ≤ 25 mmHg OR Lactate > 4 mMol

Basic Life Support

  • Supplemental 100% Oxygen

Advanced Life Support

  • Full ALS Assessment and Treatment
  • Notify hospital of incoming Sepsis Alert prior to arrival
  • IV 0.9% NaCl en route
    • Administer 250 ml boluses until systolic BP > 90 mmHg
    • Total amount of IVF should not exceed 2000 ml
    • Boluses may be given in rapid succession if systolic remains < 90 mmHg
  • If systolic BP remains < 90 mmHg after 4th fluid bolus (1000 ml):
    • Dopamine infusion at 5-20 mcg/kg/min titrated to maintain systolic BP > 90 mm Hg