Sepsis

Question 1

Differential Diagnosis

Answer 1

• Infection (pneumonia, UTI, cellulitis,
  abscess, gastrointestinal)
• Malignancy
• Heat Related illness
• Hyperthyroid
• Meningitis
• Hyperglycemia/hypoglycemia
• Overdose (sympathomimetic,
  anticholinergic)

Question 2

S/S

Answer 2

• SOB/Tachypnea
• Hypotension/Pale
• Extreme Pain
• Fever/Chills
• ALOC/Fatigue
• Tachycardia

Question 3

How do we determine if the pt might be Septic?

Answer 3

• If they classify as a suspect
• 2 or > SIRS Criteria are met

Question 4

Risk Factors for Adults (Suspects for Sepsis)

Answer 4

• Open wounds, sores, or cellulitis
• Active infections (UTI, pneumonia, meningitis)
• Indwelling medical devices (ports, stents, hardware)
• Recent surgery or procedure
• Chemotherapy in the past 6 weeks
• Immunosuppression (chronic steroid use, diabetes,
  untreated HIV)
• IV drug use

Question 5

Risk Factors for Peds (Suspects for Sepsis)

Answer 5

• Malignancy
• Asplenia/sickle cell disease
• Bone marrow transplant
• Indwelling medical device
• Solid organ transplant
• Severe intellectual disability
• Immunocompromise

Question 6

Systemic Inflammatory Response Syndrome (SIRS) Criteria (Adults)

Answer 6

Temp: 100 or >; 97 or <
HR: 90 or >
RR: 20 or >

Glucose > 140 in non-diabetic
Altered mental status

Question 7

Systemic Inflammatory Response Syndrome (SIRS) Criteria (Peds)

Answer 7

0-2 yr:
HR >190
RR >50

2-10 yr:
HR >140
RR >34

10-14 yr:
HR >100
RR >30

• Capillary refill delayed > 2 sec
• Mental status: decreased arousability, irritable

Question 8

Findings of Shock (Adults)

Answer 8

• SBP <90 or MAP < 65 or SBP drop of 40 mmHg from prior baseline
• EtCO2: 25 or <
• O2 sat 92% or < on RA
• Mottled or Cold extremities
• Central cap refill 3sec or >
• Purpuric rash
• No radial pulse

No Improvement from from Fluid Resuscitation

Question 9

Findings of Shock (Peds)

Answer 9

• SBP <70 + (age in yr x 2)
• 3 or more exam criteria
• 2 or more exam criteria in high risk patient

Question 10

Initial Actions

Answer 10

• Determine if Sepsis Suspect
• Determine if Septic Positive (SIRS)

Question 11

TX

Answer 11

• Obtain full set of VS
• Provide Supplemental O2 to obtain SpO2 of 94% or >
• EtCO2
• IV Access (18g x2)
• 30 mL/kg LR fluid bolus (max 3 L)
  *Reassess every 500 mL and hold administration if Pt developes signs of fluid overload
• Consider Shock AG (Push Dose Epi)