Protocol 53 - Adult Suspected Sepsis.PNG

# Protocol 53: Adult Suspected Sepsis ## Initial Medical Care ### History * Duration and severity of fever * Past medical history * Medications/recent antibiotics * Immunocompromised (transplant, HIV, diabetes, cancer) * Indwelling medical device * Last acetaminophen or ibuprofen * Recent hospital...

# Protocol 53: Adult Suspected Sepsis ## Initial Medical Care ### History * Duration and severity of fever * Past medical history * Medications/recent antibiotics * Immunocompromised (transplant, HIV, diabetes, cancer) * Indwelling medical device * Last acetaminophen or ibuprofen * Recent hospital/healthcare facility stay * Bedridden or immobile * Elderly and very young-at-risk * Prosthetic device/indwelling device ### Signs and Symptoms * Warm * Flushed * Sweaty * Chills/rigors * Delayed cap refill * Mental status changes ### Associated Symptoms * (helpful to localize source) * Myalgia, cough, chest pain, headache, dysuria, abdominal pain, rash ### Differential * Infections: UTI, Pneumonia, Skin/wound * Cancer/Tumors/Lymphomas * Medication or drug reaction * Connective tissue disease: Arthritis, Vasculitis * Hyperthyroidism * Heat stroke * Meningitis * Hypoglycemia/hypothermia * MI/CVA ### Sepsis Screen * Obvious or suspected source of infection AND any of these SIRS (Systemic Inflammatory Response Syndrome) criteria: * SBP < 90 mmHg * Heart Rate > 90/minute * Respiratory Rate > 20 * GCS < 15 * Temperature > 100.4°F or < 96.0°F ### Pediatric SIRS Criteria * Temperature: Same as adult * Heart Rate: * 1 month - 1 year > 180 * 2-5 years > 140 * 6-12 years > 130 * 13-18 years > 120 **Decision Tree:** ```mermaid graph TD A[Sepsis Screen] -->|Positive?| B{YES}; A -->|NO| C[Exit to appropriate protocol as indicated]; B --> D[Establish IV/IO]; D --> E{If SBP90 MAP>60 up to max 1000ml]; F --> G[REASSESS SIRS CRITERIA]; G --> H[May repeat additional NS bolus up to 1000ml to a max total of 2000ml as long as SIRS criteria present, unless concern with fluid overload]; H --> I[For hypotensive pediatric patient, refer to distributive shock in PEDIATRIC SHOCK PROTOCOL # 68]; C -.-> J[Exit to appropriate protocol as indicated]; subgraph EMT/Paramedic B -- EMT/Paramedic --> K; end K --> J; ``` **Sepsis Alert:** Notify receiving facility during transport. **Note:** Revised: 12/01/24 Effective: 05/01/98