About
Section 1: General Patient Care
Section 2: Medical Protocols
2.01 - Adrenal Insufficiency / Crisis (Adult & Pediatric)2.02A - Allergic Reaction / Anaphylaxis2.02P - Allergic Reaction / Anaphylaxis2.03A - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Adult2.03P - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Pediatric2.04 - Behaviorial Emergencies (Adult & Pediatric)2.05 - Behaviorial Emergencies - Restraints (Adult & Pediatric)2.06A - Bronchospasm / Respiratory Distress (Adult)2.06P - Bronchospasm / Respiratory Distress (Pediatric)2.07 - Hyperthermia (Environmental - Adult & Pediatric)2.08 - Hypothermia (Environmental - Adult & Pediatric)2.09 - Nerve Agent / Organophosphate Poisoning2.10 - Obstetrical Emergencies2.11 - Newly Born Care2.12 - Resuscitation of the Newly born2.13 - Pain and Nausea Management2.14 - Poisoning / Substance Abuse / Overdose2.15A - Seizures2.15P - Seizures2.16A - Shock2.16P - Shock2.17A - Sepsis2.17P - Sepsis2.18 - Stroke2.19 - Hyperkalemia2.20 - Home Hemodialysis Emergency Disconnect
Section 3: Cardiac Emergencies
Section 4: Trauma Protocols
Section 5: Airway Protocols & Procedures
Section 6: Medical Director Options
Section 7: Medical Policies & Procedures
Section 8: Special Operations Principles
Appendices
2.17P - Sepsis
Note:
IDENTIFICATION OF POSSIBLE SEPTIC SHOCK
- Suspected infection – YES
- Evidence of sepsis criteria - YES (2 or more):
- Temperature less than 96.8° F or greater than 100.4° F
- Heart Rate greater than normal limit for age (heart rate may not be elevated in septic hypothermic patients) AND at least one of the following indications of altered organ function
- Altered mental status (decreased, irritable, confused)
- Capillary refill time < 1 second(flash) or > 3 seconds
- Mottled cool extremities
- Decreased urine output
EMT-Basic (Standing Orders)
- 1.0 Routine Patient Care
- Notify hospital of incoming Sepsis Alert prior to arrival if applicable
- Monitor and maintain airway and breathing as these may change precipitously
- Administer oxygen and continue regardless of oxygen saturation levels
- Obtain blood glucose reading if available
- Do not delay transport
EMT-Advanced (Standing Orders)
- IV/IO fluids should be titrated to attain normal capillary refill, peripheral pulses, and level of consciousness.
- Administer fluid boluses of 20 mL/kg of 0.9% NaCl by syringe push method:
- Reassess patient immediately after completion of bolus and repeat 2 times (max 60 mL/kg) if inadequate response to boluses.
EMT-Paramedic (Standing Orders)
- If there is no response after 3 fluid boluses, contact Medical Control to consider:
- Additional fluids OR
- Epinephrine infusion: 0.1 mcg/kg/min IV/IO, titrate to maintain perfusion with a max dose of 1 mcg/kg/min.
Recommended administration via infusion pump.
Note:
PEARLS:
- To stabilize blood pressure-titrate infusions to maintain perfusion.
- Blood pressure can be assessed by using this formula: 70+(age in years times 2).
- Sepsis is a systemic inflammatory response due to infection. Frequent causes of septic shock include urinary, respiratory, or gastrointestinal infections and complications from catheters and feeding tubes.
- Patient who are immuno-compromised are also susceptible to sepsis.
- Septic shock has a high mortality and is one of the leading causes of pediatric deaths.
- Aggressive IV therapy and early antibiotic significantly reduce death.